New Drugs for PMR Could Mean Less Prednisone — Here’s What You Need to Know

Most PMR patients are prescribed a medication that was never actually approved for their condition.

And almost no one talks about it.

Prednisone is the standard treatment for PMR—but it is not FDA approved for PMR. Not in the label. Not in the official indications. Not in pharmacy school training.

Yet it’s been used for decades because it works so well that, in some cases, doctors even rely on a patient’s response to prednisone to help confirm the diagnosis.

Here’s what surprised me most as a pharmacist: I had never even heard of PMR before I started specializing in prednisone use.

And recently, I sat in a Harvard Medical School seminar with some of the world’s leading PMR researchers—including the physician behind the largest PMR study ever conducted.

What I learned there changes how we should be thinking about PMR treatment today.

Let me walk you through it.

Watch now!

How Did We Get Here?

How does a drug become the universal treatment of choice for a condition it was never approved for?

I could cover a whole bunch of regulatory laws and changes over the years at the FDA, but it really comes back to this:

PMR is driven by inflammation—particularly a few inflammatory proteins, one of which is called IL-6 (interleukin-6).

Prednisone suppresses that inflammation powerfully and fast.

Most people with PMR feel dramatically better within 24 to 48 hours after the first dose of prednisone.

If you give someone prednisone and their PMR symptoms go away almost overnight, that rapid response confirms the diagnosis.

So prednisone works. Nobody disputes that.

But There’s a Problem

Prednisone works as a broad suppressor of your immune system—not just the specific inflammatory pathway that PMR is triggering.

And because PMR is a long-term condition (12 to 24 months at minimum, and for many of you, much longer), that broad suppression comes at a real cost.

What Patients Are Actually Saying

A peer-reviewed study published in 2025 in the journal Rheumatology Advances in Practice analyzed over 1,000 social media posts from real PMR and GCA (giant cell arteritis) patients who were writing to each other—not to doctors.

Here’s What Those Researchers Found:

61% of treatment comments were negative.

The top frustrations:

• Side effects and intolerability
• Flares during tapering
• The feeling that the medication was losing its effectiveness over time
• A desperate desire to taper off faster, but feeling completely trapped with no other options

That study also found that patients viewed biologic medications significantly more positively than glucocorticoids like prednisone.

Patients were asking: “Isn’t there something else? Anything?”

And for a very long time, the honest answer was: Not really.

But now it’s different.

The First FDA-Approved Drug for PMR

In 2023, the FDA actually approved a drug for PMR.

The drug is called Sarilumab, and the brand name is Kevzara.

Specifically for PMR—polymyalgia rheumatica.

And I want to emphasize that specifically. This is not another off-label indication.

Sarilumab is the first drug in history actually FDA approved for PMR.

How Kevzara Works

Sarilumab is an IL-6 receptor inhibitor.

Remember that IL-6 protein I mentioned earlier—one of those driving PMR inflammation? Well, Sarilumab (Kevzara) blocks it.

The drug targets the root cause of the inflammation more specifically than prednisone can.

And it’s given as an injection under the skin every two weeks.

The SAFER Trial Results

In the SAFER trial—the study that led to FDA’s approval of Kevzara—28% of patients on Kevzara achieved sustained remission at 52 weeks.

Compare that to 10% of patients on prednisone alone.

Now, I want to be real with you about what that really means.

28% is truly statistically significant. It is genuinely better than prednisone.

Roughly one in three Kevzara patients achieved sustained remission. That means they were off prednisone, off other treatments, and the PMR didn’t flare.

So it was one in three for Kevzara, and then only one in 10 prednisone patients achieved sustained remission at one year.

That is a meaningful improvement over prednisone.

But It’s Not a Cure

Two out of three Kevzara patients still didn’t achieve that outcome after a whole year of treatment.

However, the patients that did benefit ended up taking significantly less prednisone over time (the cumulative dose), which matters enormously for your long-term:

• Bone health
• Metabolism
• Blood sugar
• Everything else (those 150+ side effects I’ve covered in other videos)

So this is real progress, but it is not a magic bullet.

Who Can Get Kevzara?

Kevzara is currently approved by the FDA for people who:

• Have an inadequate response to prednisone (meaning prednisone just isn’t working well enough to control the disease)
• Can’t tolerate the taper off prednisone (you keep flaring every time you try to go down a dose)

But Kevzara is not yet a first-line treatment for people who are newly diagnosed with PMR. That’s still prednisone’s role.

The Trade-Offs

The trade-offs are real too:

• As a biologic, it carries an increased risk of infection
• It requires an injection and monitoring
• Probably the biggest problem: Cost and insurance coverage varies dramatically (though coverage has definitely improved since approval)

Regarding the infection risk: prednisone causes that too. So it’s not really a way to distinguish prednisone from Kevzara. They’re both causing an increased risk of infection.

But if you’ve been stuck on prednisone and every time you try to taper you flare, this is an option you can bring to your rheumatologist.

Many patients have no idea they can even ask about it.

What’s Coming in the Pipeline

When I was at the Harvard Medical School Seminar in Boston last year, they talked about the upcoming trials and new treatments for PMR.

I was in a room with the leading researchers of PMR and giant cell arteritis studies around the world, and I had the opportunity to learn from Dr. John Stone, a rheumatologist at Massachusetts General Hospital and Harvard Medical School, and one of the foremost experts on PMR in the country.

The REPLENISH Trial: Secukinumab (Cosentyx)

What Dr. Stone recently published—just a few weeks ago—was the latest results from the REPLENISH trial.

REPLENISH is a phase 3 clinical trial (the gold standard of medical research, the last step before FDA approval), and it involved 381 patients with PMR who had relapsing disease. These were not newly diagnosed patients.

The results were published at the International Vasculitis Workshop in 2026, a major international conference. (It hasn’t been fully published in a peer-reviewed paper yet—just at this conference.)

In this trial, a newer drug was tested called secukinumab, also known as Cosentyx.

Cosentyx is already FDA approved for ankylosing spondylitis, psoriasis, and several other inflammatory conditions. (I used to review requests by doctors to get their patients on this medication when I worked for an insurance company and reviewed prior authorization requests.)

How Cosentyx Works Differently

Instead of targeting IL-6, Cosentyx targets IL-17A—which is a different immune protein involved in inflammation.

The Results

Patients on Cosentyx had doubled the rate of sustained remission compared to placebo:

• 41% on Cosentyx achieved sustained remission
• 20% on placebo

And they needed significantly less prednisone over the course of the year.

What This Means for Vulnerable Patients

Here’s what Dr. Stone said that really made me think:

“Patients at high risk of doing poorly with prolonged prednisone—because they’re older, female, or have comorbidities like diabetes or osteoporosis—may benefit substantially from Cosentyx, potentially even as the primary treatment approach, instead of starting with prednisone.”

That’s significant.

That’s a leading Harvard researcher saying: We may be able to protect the most vulnerable PMR patients from prednisone’s worst long-term effects by starting earlier in treatment.

What This Tells Us About PMR

The fact that blocking IL-17A also works in PMR tells us something important about the disease itself:

PMR inflammation is more complex than one single inflammation pathway.

That opens the door to:

• More targeted, specific treatments
• More personalized treatments
• Matching the specific inflammatory driver to the right drug for each patient

It’s exciting that precision medicine is where rheumatology is headed.

What We Know Doesn’t Work

Now we know a lot about what works and doesn’t work for PMR, which helps us narrow down what is causing PMR inflammation.

They’ve tested a lot of really popular drugs that work for other rheumatological diseases like rheumatoid arthritis—drugs like Enbrel and Humira—and they did not help people with PMR.

Tocilizumab (Actemra): Another Option

Another drug called Tocilizumab (brand name Actemra) is another IL-6 inhibitor that has been studied in PMR.

The SEMAFOR Trial

In the SEMAFOR trial, 67% of patients on tocilizumab reached the primary endpoint, compared to 31% on prednisone alone.

The SPARE Trial

A separate trial called the SPARE trial looked at newly diagnosed PMR patients and found that Actemra helped them get off prednisone faster with fewer flares.

Actemra is already FDA approved for giant cell arteritis (GCA), which is closely related to PMR. So your rheumatologist may already know that drug very well.

Other Drugs Being Studied

Some other drugs researchers are studying include:

Rituximab – A B-cell depleting therapy (I personally had to take it for my own autoimmune disease). They’re studying it in two large Dutch trials called Reduce PMR1 and Reduce PMR2, looking at both newly diagnosed and relapsing PMR patients.

JAK inhibitors – Like tofacitinib and baricitinib. This is a big improvement because these are oral medications (pills) that are currently used in rheumatoid arthritis, but they’re showing early promise in PMR trials—though larger studies are still needed.

Why This Took So Long

I’m frankly blown away that it’s taken this long to get drugs FDA approved and studied for PMR when it’s the second most common inflammatory disease in people over 50.

But here we are. And the landscape is changing.

The Current Treatment Landscape

So here’s where we stand:

FDA-Approved Options:

• Kevzara – First FDA-approved drug specifically for PMR
• Actemra – Approved for closely related disease (GCA)

In the Pipeline:

• Cosentyx – Coming down the pipeline (I’ll bet it’ll probably get approved sometime in the next few years)
• Rituximab – In large trials
• JAK inhibitors – Showing early promise

It’s a very exciting time if you are newly diagnosed with PMR. You are not having to face a future where prednisone is your only option.

If you play the right bureaucratic games with prior authorizations and approvals, you could potentially try these drugs.

(If you’d like to know more about how to jump through those hoops, just let me know. I’ve been on the other side. I know how that works.)

The Irony

And what’s crazy is that of those drugs I’ve mentioned, prednisone is not actually FDA approved for PMR—yet it’s the standard treatment.

Think about that.

The Question to Bring to Your Next Appointment

Here’s the question to bring to your next appointment with your rheumatologist:

“Now that I’ve had a trial of prednisone and it hasn’t been going well for me—it makes me feel [insert your symptoms: insomnia, bone loss, weight gain, heart palpitations, whatever those horrible things are that prednisone is doing to you]—am I a candidate for Kevzara or another biologic medication, doctor?”

Write that question down and bring it to your next appointment.

Pro Tip for Remembering Your Questions

One tip I like to do when I have upcoming appointments: In my Google Calendar, in the notes section at the bottom of the appointment, I actually write out the questions.

So then when I’m sitting there with the doctor, I can just pull out my phone, tap on the actual calendar date when my appointment is, and it opens up with my questions right there.

“Oh, should we try Kevzara for PMR?”

That’s a great question to ask, but you might not remember it in your short 7-minute appointment with your rheumatologist.

What You Need to Know While You’re Still on Prednisone

The treatment landscape for PMR is genuinely changing, and it is an exciting time.

But if you’re watching this, you’re probably taking prednisone.

And while you’re taking it, there are things happening inside your body that most doctors—even the good ones—aren’t warning you about.

It’s not because they don’t care. It’s because your appointment wasn’t designed for this level of detail.

Protect Yourself While You’re Waiting

While you’re on prednisone—whether you’re waiting for approval for a biologic or working through a taper—your body is being systematically depleted of nutrients it needs to function.

That’s why I created Nutranize Zone—to give your body what prednisone is stealing while you’re on this medication, so you can protect your:

• Bone density (calcium, vitamin D, vitamin K2)
• Sleep (magnesium, melatonin)
• Blood sugar (chromium, berberine, cinnamon)
• Immune system (B vitamins, vitamin C, zinc)

Learn more about Nutranize Zone →

The Bottom Line

What you need to know:

1. Prednisone is not FDA approved for PMR (but it’s been the standard of care for decades)
2. Kevzara is the first FDA-approved drug specifically for PMR
3. More options are coming: Cosentyx, Actemra, and others
4. You can ask your doctor if you’re a candidate for biologics
5. The treatment landscape is changing—and that’s good news

The question to ask your doctor: “Am I a candidate for Kevzara or another biologic medication?”

You deserve options. You deserve hope. And you deserve to know what’s actually available beyond “just take more prednisone.”

The future of PMR treatment is finally catching up to what patients have been asking for all along.

References:

• Sarah L Mackie, Pallavi Arun, Vandana Padmanabhan, Alvaro Arjona, Joyce A Kullman, Patient perspectives on life impact and unmet needs in giant cell arteritis and polymyalgia rheumatica: insights from social media, Rheumatology Advances in Practice, Volume 10, Issue 1, 2026, rkaf140,
• Stone JH. “Secukinumab Achieves Doubling Remission Rate in Relapsing PMR.” Medscape Medical News. Presented at the International Vasculitis Workshop 2026; 2026. Accessed May 7, 2026.
• Dasgupta B, et al. Sarilumab for polymyalgia rheumatica (SAPHYR trial): a randomized, double-blind, placebo-controlled Phase 3 study.
• Devauchelle-Pensec V, Carvajal-Alegria G, Dernis E, et al.
• Effect of Tocilizumab on Disease Activity in Patients With Active Polymyalgia Rheumatica Receiving Glucocorticoid Therapy: A Randomized Clinical Trial.
• Bonelli M, Radner H, Kerschbaumer A, et al.
• Tocilizumab in patients with new onset polymyalgia rheumatica (PMR-SPARE): a phase 2/3 randomised controlled trial.
• Rituximab in Relapsing Polymyalgia Rheumatica (RITUX-PMR Trial ClinicalTrials.gov Identifier: NCT05533164 National Library of Medicine (NIH). Rituximab Effect on Decreasing Glucocorticoid Exposure in Polymyalgia Rheumatica Patients Experiencing a PMR Relapse.
• Interleukin-6 Inhibition Strategy Trial in PMR (REDUCE-PMR Program ClinicalTrials.gov Identifier: NCT05533125 National Library of Medicine (NIH). Study of novel therapeutic strategy in polymyalgia rheumatica (PMR).