Comparative Effectiveness of Sarilumab vs. Methotrexate as a Corticosteroid-Sparing Agent in Patients with Polymyalgia Rheumatica

August 2025

In this Journal Club discussion, Jeannette Hart, PA-C, reviews the landmark SAPHYR trial evaluating sarilumab for patients with polymyalgia rheumatica (PMR) who relapse during glucocorticoid tapering. PMR affects thousands of patients worldwide, with nearly half experiencing relapse when reducing prednisone or other glucocorticoids. For decades, treatment options were limited to steroids despite their well-known side effects and long-term risks. This episode highlights how IL-6 receptor blockade with sarilumab offers the first FDA-approved steroid-sparing therapy for PMR. Jeannette walks through the trial design, inclusion and exclusion criteria, dosing strategies, endpoints, and key outcomes—demonstrating that patients treated with sarilumab achieved significantly higher sustained remission compared to placebo. We also examine safety findings, glucocorticoid toxicity scores, and the clinical implications for managing PMR in real-world practice. Whether you are a rheumatology provider, trainee, or clinician looking to expand treatment knowledge, this deep dive provides valuable insights into the future of PMR care.