Steroid-sparing Effects of Etanercept in a Patient with Steroid-dependent Adult-onset Still's Disease

Kiyonaga, Yasuhiro; Maeshima, Keisuke; Imada, Chiharu; Haranaka, Miwa; Ishii, Koji; Shibata, Hirotaka

doi:10.2169/internalmedicine.53.1488

Cited by 11 publications

(5 citation statements)

References 33 publications

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“…Biologics such as tocilizumab, etanercept and anakinra have demonstrated good outcomes, especially in refractory EOSD or in case of complications [22,23,28,31,35,38,58,59]. These treatments need to be prescribed carefully in EOSD because of serious adverse events including opportunistic infections, anaphylactic reactions or biologic-associated macrophage activation syndrome [26,31].…”

Section: Discussionmentioning

confidence: 99%

Elderly-onset adult Still’s disease

et al. 2021

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Adult-onset Still's disease is a rare inflammatory disorder usually affecting young adults. Elderly-onset Still's disease (EOSD) is reported in some cases, commonly in Japan, the USA and Europe. One of the most commonly used criteria for diagnosing EOSD is Yamaguci criteria. In elderly patients more severe course of the disease and more complications may be expected than in the younger group of patients with Still's disease. The lungs involvement is rather rare manifestation of this disease. In our article we discuss the problem of both the development of Still's disease in the elderly and interstitial lung changes in the course of the disease, based on available literature and own cases from one centre.

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Section: Discussionmentioning

confidence: 99%

Elderly-onset adult Still’s disease

et al. 2021

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“…Stimulated by encouraging results from the treatment of other chronic inflammatory joint diseases (especially RA), TNF inhibitors were the first biologic agents used for AoSD [78][79][80][81][82][83] . However, driven by the deceptive impression that AoSD with a predominant arthritic phenotype is a subgroup of seronegative RA, the results from uncontrolled trials -usually involving small cohorts of patients -were inconsistent (Table 4).…”

Section: Tnf Inhibitionmentioning

confidence: 99%

Mechanisms, biomarkers and targets for adult-onset Still’s disease

2018

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Adult-onset Still's disease (AoSD) is a rare but clinically well-known, polygenic, systemic autoinflammatory disease. Owing to its sporadic appearance in all adult age groups with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications, AoSD is an unsolved challenge for clinicians with limited therapeutic options. This Review provides a comprehensive insight into the complex and heterogeneous nature of AoSD, describing biomarkers of the disease and its progression and the cytokine signalling pathways that contribute to disease. The efficacy and safety of biologic therapeutic options are also discussed, and guidance for treatment decisions is provided. Improving the approach to AoSD in the future will require much closer cooperation between paediatric and adult rheumatologists to establish common diagnostic strategies, treatment targets and goals.

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“…Tumour necrosis factor inhibition can be considered as thirdline treatment for patients with AOSD, preferentially with chronic arthritis, as shown in some uncontrolled trials involving small cohorts of patients. [44][45][46][47][48][49] Tadekinig alfa, a recombinant human IL-18-binding protein, was investigated in an open-label study and showed promising results for efficacy in AOSD. 50 Canakinumab is a specific IL-1β antagonist, which has been approved for the treatment of different autoinflammatory diseases, including children aged >2 years with sJIA, adults and children aged >2 years with cryopyrin associated periodic syndrome (CAPS), TNF receptor associated periodic syndrome (TRAPS) and familial mediterranean fever (FMF).…”

Section: How Might This Impact On Clinical Practice or Future Developments?mentioning

confidence: 99%

Canakinumab for Treatment of Adult-Onset Still’s Disease to Achieve Reduction of Arthritic Manifestation (CONSIDER): phase II, randomised, double-blind, placebo-controlled, multicentre, investigator-initiated trial

et al. 2020

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BackgroundInhibition of interleukin (IL)-1 represents a promising treatment option in adult-onset Still's disease (AOSD).ObjectiveTo investigate the efficacy and safety of canakinumab in patients with AOSD and active joint involvement by means of a multicentre, double-blind, randomised, placebo-controlled trial.MethodsPatients with AOSD and active joint involvement (tender and swollen joint counts of ≥4 each) were treated with canakinumab (4 mg/kg, maximum 300 mg subcutaneous every 4 weeks) or placebo. The primary endpoint was the proportion of patients with a clinically relevant reduction in disease activity at week 12 as determined by the change in disease activity score (ΔDAS28>1.2).ResultsAt enrolment, patients had high active disease with a mean DAS28(ESR) of 5.4 in the canakinumab and 5.3 in the placebo group, respectively. In the intention-to-treat analysis, 12 patients (67%) in the canakinumab group and 7 patients (41%) in the placebo group fulfilled the primary outcome criterion (p=0.18). In the per-protocol analysis, significantly higher American College of Rheumatology (ACR) 30% (61% vs 20%, p=0.033), ACR 50% (50% vs 6.7%, p=0.009) and ACR 70% (28% vs 0%, p=0.049) response rates were observed in the canakinumab group compared with the placebo group. Two patients in the canakinumab group experienced a serious adverse event.ConclusionAlthough the study was terminated prematurely and the primary endpoint was not achieved, treatment with canakinumab led to an improvement of several outcome measures in AOSD. The overall safety findings were consistent with the known profile of canakinumab. Thus, our data support indication for IL-1 inhibition with canakinumab in AOSD.

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Steroid-sparing Effects of Etanercept in a Patient with Steroid-dependent Adult-onset Still's Disease

Cited by 11 publications

References 33 publications

Elderly-onset adult Still’s disease

Elderly-onset adult Still’s disease

Mechanisms, biomarkers and targets for adult-onset Still’s disease

Canakinumab for Treatment of Adult-Onset Still’s Disease to Achieve Reduction of Arthritic Manifestation (CONSIDER): phase II, randomised, double-blind, placebo-controlled, multicentre, investigator-initiated trial

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