Comparison of Early vs. Delayed Anakinra Treatment in Patients With Adult Onset Still's Disease and Effect on Clinical and Laboratory Outcomes

Abstract

Background: Aim of this study was to search for any difference in the outcome of patients with adult onset Still's disease (AOSD) treated with anakinra (ANK) in relation with the interval between disease onset and the start of anti-interleukin(IL)-1 treatment and according with the different lines of ANK treatment.Results: No significant differences were identified in the ANK effectiveness and frequency of primary or secondary inefficacy for patients starting ANK within 6 months (p = 0.19, p = 0.14, and p = 0.81, respectively) or 12 months (p = 0.37, p = 0.23, and p = 0.81, respectively) since AOSD onset compared with patients starting ANK thereafter; no significant differences were identified in ANK effectiveness and primary or secondary inefficacy according with different lines of ANK treatment (p = 0.06, p = 0.19, and p = 0.13, respectively). Patients starting ANK within 6 and 12 months since AOSD onset showed a significantly quicker decrease of erythrocyte sedimentation rate and C-reactive protein than observed among patients undergoing ANK treatment after 6 and 12 months. The number of swollen joints at the 3 month follow-up visit was significantly lower among patients undergoing ANK within 6 months since AOSD onset (p = 0.01), while no significance was identified at the 6 and 12 month assessments (p = 0.23 and p = 0.45, respectively). At the 3 and 6 month visits, the number of swollen joints was significantly higher among patients previously treated with conventional and biological disease modifying anti-rheumatic drugs (DMARDs) compared with those formerly treated only with conventional DMARDs (p < 0.017).Conclusions: Clinical and therapeutic outcomes are substantially independent of how early ANK treatment is started in AOSD patients. However, a faster ANK effectiveness in controlling systemic inflammation and resolving articular manifestations may be observed in patients benefiting from IL-1 inhibition as soon as after disease onset.

Interleukin-1 Blockade in Polygenic Autoinflammatory Disorders: Where Are We now?

“…To conclude, clinical and therapeutic outcomes are independent of early anakinra treatment initiation. However, faster response to control systemic and articular manifestation may be observed in patients with early intervention after disease onset ( Vitale et al, 2-2020 ).…”

Adult-onset Still’s disease: A disease at the crossroad of innate immunity and autoimmunity

“…In the same year, a panel of Italian experts established 11 evidence- and consensus-based statements, including that it is relatively safe and effective to use anti-IL-1 therapies in refractory AOSD patients, especially those with the systemic pattern, and it could be both first and subsequent lines of treatment using biologic agents ( 134 ). An updated study reported that patients could attain better remission in systemic inflammation and joint manifestation if they were treated with IL-1 inhibitors as soon as possible after disease onset ( 135 ).…”

Repurposing of Biologic and Targeted Synthetic Anti-Rheumatic Drugs in COVID-19 and Hyper-Inflammation: A Comprehensive Review of Available and Emerging Evidence at the Peak of the Pandemic

“…However, given the safety of anakinra even at high doses, early and aggressive treatment (i.e. 10 mg/kg/day intravenously) is probably advisable, in line with current management of autoinflammatory diseases and macrophage activation syndrome (Grom et al, 2016;Ravelli et al, 2016;Eloseily et al, 2020;Vitale et al, 2020). Clinical trials of anakinra in COVID-19 are ongoing (i.e.…”