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
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- "Though IL-1 appears to be involved in the delayed hypersensitivity to Mtb, this cytokine does not appear to play a key role in the control of Mtb infection, thus explaining the little or absent risk of developing tuberculosis in patients treated with anti-IL-1 agents. Notably, anakinra has been used on a large number of patients with several diseases (7964 with rheumatoid arthritis, 216 with juvenile idiopathic arthritis, 35 with adultonset Still's disease, and – more recently – in different autoinflammatory diseases and in gout) without showing cases of active tuberculosis87888990919293949596979899100101102103104105106. Furthermore, data from a Canadian registry have disclosed that the use of biological and traditional disease-modifying antirheumatic drugs is associated with an increased risk of developing tuberculosis in patients with rheumatoid arthritis, mainly among noncurrent users of corticosteroids. "
ABSTRACT: The study objective was to report treatment with an interleukin (IL)-1 receptor antagonist, anakinra, in patients with multiorgan Behcet's disease (BD). Comparison of clinical manifestations, previous treatments, markers of inflammation, concomitant medications, treatment regimen modifications, relapses, and adverse events before and during anakinra administration among patients with BD were evaluated. Nine BD patients (mean age 34.55 ± 16.30 years) refractory to tumor necrosis factor blockers and standardized therapies are reported in our survey. Their mean age at disease onset was 25 ± 13.88 years and their overall disease duration was 9.55 ± 5.33 years. All patients were positive for the HLA-B51 allele. Within 1 or 2 weeks following the initiation of anakinra, eight out of nine patients promptly responded, and most of them were maintained on 100 mg of daily anakinra with low doses of prednisone. However, most patients experienced a relapse in one or more clinical manifestations over time (mean time to relapse 29 ± 21.65 weeks), and only one patient remained completely under control on anakinra monotherapy. Despite a relapse in one or more disease manifestations, treatment was continued in most patients for a mean period of 13.75 ± 6.49 months. No serious adverse events occurred. Eight out of nine refractory BD patients showed a prompt improvement after starting anakinra, supporting the concept that IL-1 plays a pathological role in this disease. Nevertheless, after several months, most patients experienced a relapse. It remains unclear whether increasing the dose of anakinra would have prevented the reoccurrence of disease activity.
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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]. "
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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ABSTRACT: Der adulte Morbus Still (engl. „adult onset Still’s disease“, AOSD) mit einer Inzidenz zwischen 1 und 3 Fällen pro 1 Mio. Einwohner gehört zu den diagnostisch aufwendigsten Fiebererkrankungen. Das Fehlen von Biomarkern und seine Ähnlichkeit mit infektiösen, malignen und rheumatischen Erkrankungen führt häufig zu einer protrahierten Diagnose. Der vorliegende Beitrag soll daher versuchen, über den Kenntnisstand der klinisch relevanten Symptome, die Laborparameter für die Diagnostik des AOSD sowie die neuen Therapiemöglichkeiten eine Übersicht zu geben.
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