Efficacy and safety of tocilizumab in adult-onset Still's disease: Real-life experience from the international AIDA registry

Sota, Jurgen; Vitale, A.; Lopalco, Giuseppe; Pereira, Rosa Maria Rodrigues; Giordano, Heitor F.; Antonelli, Isabele P. B.; Makowska, Joanna; Brzezińska, Olga; Lewandowska–Polak, Anna; Ruscitti, Piero; Cipriani, Paola; Cola, Ilenia Di; Govoni, Marcello; Ruffili, Francesca; Sfikakis, Petros P.; Laskari, Katerina; Ragab, Gaafar; Hussein, Mohamed; Gentileschi, Stefano; Gaggiano, Carla; Torre, Francesco La; Maier, Armin; Emmi, Giacomo; Marino, Achille; Ciccia, Francesco; Sfriso, Paolo; Maggio, Maria Cristina; Bartoloni, Elena; Lomater, Claudia; Hegazy, Mohamed Tharwat; Tektonidou, Maria G; Dagostin, Marília A.; Opinc, Aleksandra; Sebastiani, Gian Domenico; Giacomelli, Roberto; Giudice, Emanuela Del; Olivieri, Alma Nunzia; Tufan, Abdurrahman; Kardas, Riza Kan; Nuzzolese, Rossana; Cardinale, Fabio; Więsik-Szewczyk, Ewa; Veronica, Parretti; Tarsia, Maria; Iannone, Florenzo; Casa, Francesca Della; Fabiani, Claudia; Frediani, Bruno; Balistreri, Alberto; Rigante, Donato; Cantarini, Luca

doi:10.1016/j.semarthrit.2022.152089

Cited by 15 publications

(7 citation statements)

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“…Inhibition of IL-1 or IL-6 has clearly demonstrated to be effective in controlling clinical and laboratory inflammatory manifestations of Still’s disease, with a strong glucocorticoid sparing effect and a tolerable safety profile ( 21 , 24 , 25 ). Despite the lack of internationally shared treatment guidelines, the current approach supports the use of IL-1 inhibitors in patients with Still’s disease ( 14 , 16 ), while IL-6 antagonists may represent an effective treatment choice in refractory cases with persistent inflammatory joint involvement ( 15 , 17 ). Different cytokine imbalances identified based on the different patterns of the disease (systemic versus chronic-articular) could suggest different molecular targets when establishing a personalized treatment approach in Still’s disease ( 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

Canakinumab as first-line biological therapy in Still’s disease and differences between the systemic and the chronic-articular courses: Real-life experience from the international AIDA registry

et al. 2022

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ObjectiveInterleukin (IL)-1 inhibitors are largely employed in patients with Still’s disease; in cases with refractory arthritis, IL-6 inhibitors have shown to be effective on articular inflammatory involvement. The aim of the present study is to assess any difference in the effectiveness of the IL-1β antagonist canakinumab prescribed as first-line biologic agent between the systemic and the chronic-articular Still’s disease.MethodsData were drawn from the retrospective phase of the AutoInflammatory Disease Alliance (AIDA) international registry dedicated to Still’s disease. Patients with Still’s disease classified according to internationally accepted criteria (Yamaguchi criteria and/or Fautrel criteria) and treated with canakinumab as first-line biologic agent were enrolled.ResultsA total of 26 patients (17 females, 9 males; 18 patients developing Still’s disease after the age of 16 years) were enrolled; 16 (61.5%) patients suffered from the systemic pattern of the disease; 10 (38.5%) patients suffered from the chronic-articular type. No differences were observed between the systemic and the chronic-articular Still’s disease in the frequency of complete response, of flares after the start of canakinumab (p = 0.701) and in the persistence in therapy (p = 0.62). No statistical differences were observed between the two groups after 3 months, 12 months and at the last assessment in the decrease of: the systemic activity score (p = 0.06, p = 0.17, p = 0.17, respectively); the disease activity score on 28 joints (p = 0.54, p = 0.77, p = 0.98, respectively); the glucocorticoid dosage (p = 0.15, p = 0.50, and p = 0.50, respectively); the use of concomitant disease modifying anti-rheumatic drugs (p = 0.10, p = 1.00, and p = 1.00, respectively). No statistically significant differences were observed in the decrease of erythrocyte sedimentation rate (p = 0.34), C reactive protein (p = 0.48), and serum ferritin levels (p = 0.34) after the start of canakinumab.ConclusionCanakinumab used for Still’s disease has been effective in controlling both clinical and laboratory manifestations disregarding the type of disease course when used as first-line biotechnological agent. These excellent results might have been further enhanced by the early start of IL-1 inhibition.

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Section: Discussionmentioning

confidence: 99%

Canakinumab as first-line biological therapy in Still’s disease and differences between the systemic and the chronic-articular courses: Real-life experience from the international AIDA registry

et al. 2022

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“…Table 1). An additional multicenter registry study, which was published after the formal literature review for the present guidelines was closed, confirmed a significant dose reduction of daily prednisone from 18 to 4 mg in 31 AOSD patients on tocilizumab [195].…”

Section: Overarching Principles Statements and Recommendationsmentioning

confidence: 82%

Diagnosis and treatment of adult-onset Still’s disease: a concise summary of the German society of rheumatology S2 guideline

et al. 2022

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“…[10] As recent studies have shown the importance of IL-6 in its pathogenesis, tocilizumab is now used for the treatment of refractory AOSD. [11] Our patient had AOSD for 15 years and underwent treatment with various medications, including prednisolone and cyclosporine; however, these therapies could not control her disease. Therefore, tocilizumab was initiated.…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab-induced mucosal injury in the terminal ileum mimicking intestinal Behçet’s disease: A case report

et al. 2023

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Rationale: Tocilizumab, a humanized anti-interleukin-6 (IL-6) receptor monoclonal antibody, is used for the treatment of adultonset Still disease (AOSD). Despite its efficacy in many clinical situations, concerns have been raised regarding intestinal mucosal injury in patients receiving tocilizumab.Patient concerns: A 64-year-old woman with a history of AOSD was admitted to our hospital with hematochezia. She had AOSD for 15 years and underwent treatment with biweekly tocilizumab 9 months prior to admission. Colonoscopy revealed a large punched-out ulcer in the terminal ileum. On pathological evaluation, nonspecific enteritis with lymphocytes and eosinophils were seen. Based on the location and shape of the lesion, we suspected intestinal Behçet's disease. However, the ulcer reduced in size over time by discontinuation of tocilizumab without additional drug treatment, indicating that it was a drug-induced ulcer.

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Efficacy and safety of tocilizumab in adult-onset Still's disease: Real-life experience from the international AIDA registry

Cited by 15 publications

References 32 publications

Canakinumab as first-line biological therapy in Still’s disease and differences between the systemic and the chronic-articular courses: Real-life experience from the international AIDA registry

Canakinumab as first-line biological therapy in Still’s disease and differences between the systemic and the chronic-articular courses: Real-life experience from the international AIDA registry

Diagnosis and treatment of adult-onset Still’s disease: a concise summary of the German society of rheumatology S2 guideline

Tocilizumab-induced mucosal injury in the terminal ileum mimicking intestinal Behçet’s disease: A case report

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