Methotrexate or Rinvoq to treat GCA

I have PMR and presumed GCA. I take prednisone. Methotrexate did not help and the side effects were bad ( severe nausea for the first month, elevated liver enzymes ). I have also been on Kevzara and Tyenne. Neither one allowed me to reduce prednisone. My doctor is now suggesting Rinvoq. I am concerned because it has a "boxed warning" from the FDA. In clinical trials there was a higher incidence of cancer and, I believe, also heart attack and stroke. I'm looking for more information on exactly how many people were affected in the trial. I'm sure the percentage is small but to my knowledge Kevzara and Tyenne do not have a boxed warning. From what I have learned Rinvoq works inside the cells to block an inflammation pathway while Tyenne and Kevzara block receptor sites on the outside of cells. I'm sure that is over-simplification but it apparently works in a different way than the other drugs. I am inclined at this point not to go on Rinvoq but keep it as a last resort if prednisone starts to cause more obvious problems. I'm sure your situation if different but that's my take.

My brother-in-law has been taking methotrexate for 14 years to treat PMR. He hasn't had any issues with it.

Have you checked to see if your insurance covers Avtozma or Tofidence? Those are 2 other biosimilars of tocilizumab. Google says they are both administered with infusions, so if they are covered by insurance, it would be under Part B.

My doctor prescribed Avtozma and my insurance approved it, but the specialty pharmacy says there's a long term shortage of Avtozma.

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I have had PMR for 3.5 yrs, GCA for 1 yr. I had severe vertigo acutely after third dose of Actemra SQ. May or may not have been a side effect of Actemra, not clear to me, but I changed to Rinvoq 15 mg. Have completed 4 months of Rinvoq, prednisone is down to 1 mg daily. I feel well overall, best I’ve felt in 3 years, fingers crossed that this continues.

@bk557
Thanks for replying so fast. I appreciate every bit of information. Funny, the "self correcting" spelling put "inflammation " instead of information!!!!
It has a sense of humor I guess!
I've heard many medicines are in short supply. Appreciate your help.

@mark2471
Appreciate hearing your experience with these drugs. I've had "positional vertigo" over the years, although not for the last 4 yrs, but it's not something I'd like to experience again either. I saw that Rinvoq has a "box warning" from the FDA? It's great you're down so low on the Prednisone and feeling good. I pray it continues for you and you're able to get completely off Prednisone and all other PMR meds.
Thank you again for your help.

I began taking 15 mg daily of Rinvoq in June of last year ( 2025) while tapering my dosage of prednisone to address GCA. I too was concerned about the possible side effects but I have had no problems and no relapse of GCA. Besides my regular appointments with my rheumatologist, I have my blood drawn and tested every three months to check for any irregularities. My rheumatologist would like me to continue taking the drug for another nine months to ensure I stay in remission. I personally have found Rinvoq to be a blessing compared to prednisone. Introducing Rinvoq early enabled me to taper off of prednisone ten months following the onset of my GCA.

I’ve been on Rinvoq for 10 months. I’m down to 1 mg of prednisone. I’ve had no ill affects from Rinvoq. The medicine does carry a warning of Diverticulitis if you’ve had it before so I keep an eye out for that but otherwise it’s working great for me.