Anakinra in adult-onset Still's disease: long-term treatment in patients resistant to conventional therapy.

Abstract

OBJECTIVE:

Anakinra is effective in adult-onset Still's disease (AOSD) in the short term, but little is known regarding its efficacy over the long term. Our objective was to assess the long-term efficacy and safety of anakinra in AOSD.

METHODS:

A nationwide survey was conducted between 2009 and 2010 to identify AOSD patients treated with anakinra. Collected data consisted of disease characteristics at diagnosis and at medication onset; anakinra efficacy, safety, and dose adaptation; and reasons for discontinuation, if applicable.

RESULTS:

The study included 28 AOSD patients, with a mean age of 40.3 years and a mean disease duration at the start of anakinra of 9.3 years. All patients had previously failed to respond to steroids and disease-modifying antirheumatic drugs. All patients responded to anakinra, with a rapid and sustained decrease in steroid doses. At the last followup (mean 23 months), 16 patients were still being treated with anakinra: 4 had a partial response and 12 were in complete remission. Twelve patients had discontinued anakinra: 2 due to an insufficient response, 4 due to an AOSD flare after a period of complete remission, 2 due to side effects, and 1 due to a desire for pregnancy. In 3 patients, the drug discontinuation was possible because they achieved complete remission. Six additional patients experienced anakinra dose tapering, with sustained remission in 2 and relapse in the others. Anakinra was well tolerated and adverse events were rated as mild.

CONCLUSION:

Anakinra was consistently efficacious in AOSD and displayed good therapeutic maintenance. Anakinra dose tapering or discontinuation was associated with relapse in half of the patients.

• Authors: Cecilia Giampietro, Meriem Ridene, Thierry Lequerre, Nathalie Costedoat Chalumeau, Zahir Amoura, Jérémie Sellam, Jean Sibilia, Pierre Bourgeois, Bruno Fautrel, CRI (Club Rhumatismes et Inflammation)
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 65 Issue 5 Pg. 822-6 (May 2013) ISSN: 2151-4658 [Electronic] United States
• PMID: 23225779 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 by the American College of Rheumatology.

Chemical References

• Antirheumatic Agents
• Interleukin 1 Receptor Antagonist Protein

Topics

• Adolescent
• Adult
• Aged
• Antirheumatic Agents (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Interleukin 1 Receptor Antagonist Protein (therapeutic use)
• Male
• Middle Aged
• Retrospective Studies
• Still's Disease, Adult-Onset (diagnosis, drug therapy, epidemiology)
• Time Factors
• Treatment Outcome
• Young Adult