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Tocilizumab in adult-onset Still's disease: the Israeli experience.

AbstractOBJECTIVE:
To describe the Israeli experience of treating adult-onset Still's disease (AOSD) with tocilizumab (TCZ).
METHODS:
Israeli rheumatologists who treated AOSD with TCZ filled in questionnaires on symptoms, number of tender and swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and dosage of prednisone at initial TCZ administration, after 6 months, and at the end of followup.
RESULTS:
Nine male and 6 female patients, aged 33 ± 12 years, mean disease duration 9 years (range: 1-25) were identified. They had used a mean of 3.6 disease-modifying drugs, including 10 patients with tumor necrosis factor blockers. Intravenous TCZ 8 mg/kg was administered every 4 weeks (12 patients) or every 2 weeks (3 patients). All patients completed at least 6 months of treatment. The mean followup period was 15.7 ± 9 months. At the onset of therapy, despite the use of prednisone (27.6 ± 26.3 mg/d), all patients reported joint pain. Fever was reported in 9 patients, rash in 7, pleuritis in 3, and hepatitis in 2 before TCZ use, with mean ESR and CRP levels of 60 ± 28 mm/h and 11.6 ± 15 mg/dl, respectively. After 6 months of treatment and at the end of followup, the number of tender and swollen joints, the ESR and CRP levels, and the prednisone dosage decreased significantly. Only 2 patients still complained of mild arthralgias, and none reported systemic symptoms at the end of followup.
CONCLUSION:
TCZ 8 mg/kg was extremely efficacious in treating adult patients with refractory Still's disease. Both TCZ and interleukin 1 blockade should be considered in the treatment algorithm of AOSD. Randomized controlled studies are needed to validate these findings.
AuthorsOri Elkayam, Nizar Jiries, Zvi Dranitzki, Shay Kivity, Merav Lidar, Ofer Levy, Jacob Ablin, Mahmoud Abu-Shakra, Hagit Savargyl-Maman, Hagit Padova, Dan Caspi, Itzhak Rosner
JournalThe Journal of rheumatology (J Rheumatol) Vol. 41 Issue 2 Pg. 244-7 (Feb 2014) ISSN: 0315-162X [Print] Canada
PMID24429168 (Publication Type: Journal Article)
Chemical References
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • tocilizumab
  • Prednisone
Topics
  • Adult
  • Antibodies, Monoclonal, Humanized (therapeutic use)
  • Antirheumatic Agents (therapeutic use)
  • Female
  • Humans
  • Israel
  • Male
  • Middle Aged
  • Prednisone (therapeutic use)
  • Still's Disease, Adult-Onset (drug therapy)
  • Treatment Outcome

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