Fibromyalgia Patients may benefit from Tocilizumab (Actemra)

That what an article published August 10, 2023, on HCP Live says.

Now, it’s important to note that fibromyalgia isn’t well understood. That can make it hard to treat because we don’t know what treatments get to the heart of the disease. Actemra is an interleukin-6 inhibitor, often used for Still’s Disease and some other rheumatologic conditions. But, as the article says:

Investigators reported a case series of patients with fibromyalgia receiving tocilizumab treatment. Symptoms were assessed using the revised Fibromyalgia Impact Questionnaire (FIQ), which evaluated pain levels, and the 2016 criteria of the American College of Rheumatology (ACR). Symptoms were compared using the Wilcoxon signed-rank test and neutrophiles from patients with fibromyalgia and matched controls were isolated for transcriptome analysis. Each patient underwent a 40-joint sonography at baseline, including the elbows, wrists, knees, ankles, metacarpophalangeal joints, and thumb interphalangeal joints.

The FIQ and general fibromyalgia symptoms improved at both 4 and 12 weeks with 4 (67%) patients achieving a pain reduction of ≥30% at the 4-week mark and 3 (50%) achieving the same pain reduction at the 12-week mark. No significant changes in joint inflammation, as assessed by the 40-joint sonography, was observed.

There were possible differentially expressed genes identified in primary patients when compared with controls after treatment with tocilizumab. Additionally, 2 genes upregulated in patients with fibromyalgia (C3ARI and PI3) when compared with matched health controls.

The full journal article is available open access, too, in case you’re interested. In it, the authors point out:

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.

Obviously, 6 participants is a super low number. This is something that will require more research, for both those with primary or secondary fibromyalgia. It’s also going to be important to study younger people than 36, the youngest person in this study. Aside from that individual, the next youngest person was 43.

One incredibly interesting thing they noted:

Tocilizumab has been approved to treat cytokine storms in COVID-19 patients [10]. It could be interesting to investigate how FM symptoms change in patients treated with tocilizumab due to COVID-19.

I agree that this would be an interesting idea — especially because we know from another recent post that MAS is the king of cytokine storms.

Do you have fibromyalgia? If so, would you be willing to try a biologic to see if it helped your symptoms?