Successful treatment of a patient with refractory adult Still's disease by tacrolimus

Murakami, Kosaku; Fujii, Tomoyuki; Yukawa, Naoichiro; Yoshifuji, Hajime; Kawabata, Daisuke; Tanaka, Masao; Usui, Takashi; Mimori, Tsuneyo

doi:10.1007/s10165-006-0559-2

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…More than a moderate dosage of prednisolone (PSL) is often necessary as the initial therapy to improve the manifestations (2). However, not all patients achieve remission with corticosteroid monotherapy, and an additional immunosuppressant, such as methotrexate (MTX), cyclosporine and tacrolimus, may be necessary for disease remission or reducing the PSL dosage (3)(4)(5). Furthermore, over the past decade, anti-proinflammatory cytokine agent (biologics), such as infliximab, etanercept, tocilizumab, and anakinra, has proven the therapeutic efficacy in AOSD patients refractory to the conventional treatments (6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Angioedema of the Periorbital Region that Developed during Treatment with Etanercept in a Case of Refractory Adult-Onset Still's Disease

et al. 2012

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A 78-year-old Japanese man with adult-onset Still's disease that was refractory to conventional treatment, such as prednisolone (PSL) concomitant with methotrexate (MTX). Etanercept (50 mg/week) was added to PSL (12.5 mg/day) and MTX (12 mg/week). His manifestation improved dramatically, nonetheless massive edema of the periorbital region developed by the fourth injection, which kept his palpebral fissure completely closed. There was also a marked injection site reaction to etanercept. A diagnosis of angioedema due to etanercept was thus made, and the drug was discontinued. His angioedema began to ameliorate soon after antihistamines were introduced without any critical involvement, such as laryngeal obstruction.

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Section: Introductionmentioning

confidence: 99%

Angioedema of the Periorbital Region that Developed during Treatment with Etanercept in a Case of Refractory Adult-Onset Still's Disease

et al. 2012

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“…The fact that treatment with tocilizumab did not reduce the IL-18 level suggests that IL-18 is located either upstream of, or at the same level as, IL-6 in the pathogenesis of AOSD. Indeed, in the above-mentioned case in which tacrolimus was effective (23), the level of IL-18 was also reduced, suggesting that tacrolimus blocked the inflammatory cascade of AOSD at more upstream position than tocilizumab.…”

Section: Discussionmentioning

confidence: 93%

Tocilizumab Improved both Clinical and Laboratory Manifestations Except for Interleukin-18 in a Case of Multiple Drug-Resistant Adult-Onset Still's Disease

et al. 2011

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A patient with adult-onset Still's disease (AOSD) resistant to multiple drugs was treated in our hospital. Even biologics that block tumor necrosis factor (TNF) were ineffective. However, this patient responded quite well to tocilizumab, an interleukin (IL)-6 receptor blocker, suggesting that it is among the promising candidate drugs for multiple-drug resistant AOSD. Although the serum levels of most inflammatory markers such as C-reactive protein (CRP) and ferritin were reduced promptly by tocilizumab, that of IL-18 remained high. Thus, IL-18 is considered to have a further upstream position than IL-6 or to be at the same level as IL-6 in the inflammatory cascade of AOSD. This finding casts light on the pathogenesis of AOSD, and drugs that target IL-18 may prove beneficial in the treatment of this inflammatory disease.

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“…We did not observe any correlations between the response to ETN and age or gender. Only two of the 12 patients who switched from other TNF inhibitors, such as infliximab or adalimumab, responded to ETN (3,13,16,18,19,23,24,28,29,31,32), suggesting that physicians should avoid the use of ETN in patients with an inadequate response to other TNF inhibitors. Three patients requiring discontinuation of ETN due to infection have been reported (3,12,30).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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We herein report the case of an 84-year-old man with steroid-dependent adult-onset Still's disease (AOSD) whose daily steroid dose was successfully tapered after etanercept treatment. The corticosteroids worked well initially, and the patient went into remission promptly; however, he suffered a relapse due to steroid tapering. Because treatment with cyclosporine and methotrexate was ineffective, reducing the steroid dose was difficult, and the corticosteroids induced myopathy and diabetes. However, steroid tapering was accomplished in combination with etanercept therapy, and the patient's steroid-induced side effects disappeared. Etanercept should therefore be considered as a steroid-sparing treatment option in patients with steroid-responsive, steroid-dependent AOSD.

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Successful treatment of a patient with refractory adult Still's disease by tacrolimus

Cited by 9 publications

References 11 publications

Angioedema of the Periorbital Region that Developed during Treatment with Etanercept in a Case of Refractory Adult-Onset Still's Disease

Angioedema of the Periorbital Region that Developed during Treatment with Etanercept in a Case of Refractory Adult-Onset Still's Disease

Tocilizumab Improved both Clinical and Laboratory Manifestations Except for Interleukin-18 in a Case of Multiple Drug-Resistant Adult-Onset Still's Disease

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

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