Cosentyx shows promise as a steroid-sparing option in polymyalgia rheumatica

Clinical Takeaway: Patients with relapsing PMR often require repeated or prolonged glucocorticoid treatment, increasing the risk of steroid-related complications. These phase 3 results suggest IL-17A inhibition may provide a future alternative for patients who struggle to maintain remission during steroid tapering.

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease in older adults and is typically managed with glucocorticoids. New phase 3 data suggest Cosentyx (secukinumab) may help improve disease control while reducing glucocorticoid exposure in patients with relapsed disease.

In the REPLENISH trial, patients with recently relapsed PMR were randomized to secukinumab 300 mg, secukinumab 150 mg, or placebo, with all groups receiving a standardized 24-week glucocorticoid taper. Outcomes were assessed through week 52.

Sustained remission at week 52 was achieved in 41.2% of patients receiving secukinumab 300 mg and 40.6% receiving secukinumab 150 mg, compared with 20.4% of patients receiving placebo. Both secukinumab doses met the primary endpoint and all key secondary endpoints.

Secukinumab was also associated with reduced glucocorticoid exposure. Mean adjusted annual cumulative glucocorticoid doses were 1,604 mg and 1,683 mg in the 300-mg and 150-mg groups, respectively, compared with 2,093 mg in the placebo group.

The results support IL-17A inhibition as a potential new therapeutic strategy in PMR, a disease with few advanced treatment options beyond glucocorticoids.

No new safety signals were identified. Serious adverse events occurred in 13.5% of patients receiving secukinumab 300 mg, 15.9% receiving secukinumab 150 mg, and 14.2% receiving placebo. Nasopharyngitis, hypersensitivity reactions, urinary tract infections, fungal infections, and back pain were reported more frequently with secukinumab than with placebo.

Regulatory submissions for PMR have been filed in the United States, Europe, and Japan. If approved, secukinumab could expand treatment options for patients who require alternatives to long-term glucocorticoid therapy.

“PMR is an inflammatory rheumatic disease, characterized by disabling pain and stiffness in shoulders and pelvic girdle. There is an unmet need for a treatment that keeps symptoms under control over time with fewer relapses —while also reducing reliance on steroids,” said Christian Dejaco, Director, Dept. of Rheumatology, South Tyrol Health Trust, Bruneck, Italy. “I am encouraged by the REPLENISH trial results which showed that Cosentyx, with its known safety profile, can reduce flares in the longer term while lowering patients’ steroid exposure.”

Source: Stone JH, et al; REPLENISH Investigators. New Eng J Med. 2026, June 3. Phase 3 trial of secukinumab in polymyalgia rheumatica