Subcutaneous Tocilizumab May Be Effective in Refractory Fibromyalgia Patients

Abstract

Introduction: Fibromyalgia (FM) is a chronic disorder characterized by widespread pain with an enormous symptom burden. Its treatment efficacy is limited. Its pathogenesis involves immune dysregulation, which includes interleukin-6 (IL-6) production.

Methods: We herein reported a case series of FM patients receiving subcutaneous tocilizumab at our institution. FM symptoms were evaluated by the revised Fibromyalgia Impact Questionnaire (FIQR), which included pain level, and the fibromyalgianess scale based on the 2016 criteria of the American College of Rheumatology (ACR). FM symptoms were compared using the Wilcoxon signed-rank test. Neutrophils from primary FM patients and matched healthy controls were also isolated for transcriptome analysis.

Results: We presented a total of two primary and four secondary FM patients who had received subcutaneous tocilizumab for a minimum of 12 weeks. All patients had severe symptoms despite standard treatments. Patients' FIQR and fibromyalgianess both dropped at 4 and 12 weeks. Four (67%) of them reached a pain reduction of ≥30% at 4 weeks, and three (50%) reached a pain reduction of ≥30% at 12 weeks. Possible differentially expressed genes were identified in primary FM patients when compared with controls and after tocilizumab treatment.

Conclusions: FM patients likely benefited from subcutaneous tocilizumab therapy. A randomized controlled trial is needed to verify its efficacy.

Keywords: fibromyalgia; neutrophils; pain; tocilizumab.

Figure 1

Comparison of (a) widespread pain index (WPI), (b) symptom severity score (SSS), (c) fibromyalgianess score, (d) the revised Fibromyalgia Impact Questionnaire (FIQR) score, (e) level of pain, (f) level of energy, and (g) sleep quality between baseline, 4, and 12 weeks after subcutaneous tocilizumab therapy in fibromyalgia patients. The red lines denote two primary fibromyalgia patients, and the blue lines denote four concomitant fibromyalgia patients.