Naumann L, Feist E, Natusch A, et al. IL1-receptor antagonist anakinra provides long-lasting efficacy in the treatment of refractory adult-onset Still's disease

Annals of the rheumatic diseases (Impact Factor: 10.38). 02/2010; 69(2):466-7. DOI: 10.1136/ard.2009.108068
Source: PubMed
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    • "Complete resolution of clinical symptoms occurred within a few days after the initiation of treatment and was followed by normalization of acute-phase reactants, hematological parameters, and biochemical markers of systemic disease within the first three months. According to the already reported literature, the time to complete resolution of clinical activity varied from a few hours after the first injection up to two months of treatment, with most cases remitting within some days, while laboratory markers returned to normal subsequently within one week to two months [13-19]. In the two largest already published series of 15 and 8 patients, respectively, disease activity completely resolved in 60% and 90% of patients, respectively, whereas no efficacy was reported in 13% of patients in the first study [18,19]. "
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    ABSTRACT: To assess the efficacy and safety of the interleukin-1 receptor (IL-1R) inhibitor anakinra in adult patients with refractory Still's disease. Twenty-five patients (13 males and 12 females, median age 32 years, median disease duration seven months) with Still's disease were treated with subcutaneous injections of anakinra (100 mg/day). Treatment was given as adjunct therapy in 16 patients and as standalone in 9 patients for a median time of 15 months (range 1.5-71). The clinical and laboratory parameters during follow-up were recorded. In 84% of patients the clinical activity resolved completely within a few days (median time 0.2 months), and response was maintained until the last visit in all but one patient. A complete response of all disease-related symptoms (clinical and laboratory) occurred subsequently within a median time of three months in 80% of patients. A partial clinical and laboratory improvement was shown in 12% and 16% of patients, respectively. The Visualized Analogue Scale and Health Assessment Questionnaire scores significantly decreased during treatment. The proportion of patients achieving the American College of Rheumatology 20 (ACR20) score (20% improvement) was 82% at one month and improved to 100% at one year. The mean oral corticosteroid dose was significantly reduced at each visit. Anakinra was discontinued due to unresponsiveness in one patient and due to relapsing disease in another. Treatment was also withdrawn in three patients with severe skin reactions (urticaria). Seven patients experienced an infection during follow-up. The rapid and sustained response in the majority of our patients encourages the use of anakinra in adults with Still's disease.
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