ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 193

Tocilizumab in Adult Still’s Disease : The Israeli Experience

Ori Elkayam1, Nizar Jiries2, Zvi Dranitzki3, Shaye Kivity4, Merav Lidar5, Ofer Levy6, Mahmoud Abu-Shakra7, Hagit Sarvagil-Maman8, Hagit Padova8, Dan Caspi9 and Itzhak Rosner10, 1Rheumatology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel- Aviv, Israel, 2Rheumatology, Bnai Zion Medical Center, Israel, 3Medicine, Hadassah hebrew university, Jerusalem, Israel, 4Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, affliated to Sackler Faculty of Medicine, Tel-Aviv University Israel, Tel-Aviv, Israel, 5Medicine F, Sheba Medical Center, Ramat Gan, Israel, 6Rheumatology, Asaf Harofe Medical Center, 7Medicine and Rheumatology, Soroka Medical Centre and Ben Gurion University, Beer-Sheva, Israel, 8Rheumatology, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 9Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, 10Rheumatology, Bnai Zion Medical Center / Technion Faculty of Medicine, Haifa, Israel

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Miscellaneous Rheumatic and Inflammatory Diseases: Periodic Fever Syndromes

Session Type: Abstract Submissions (ACR)

Background/Purpose:

The objective of this study was to review the clinical and laboratory characteristics of patients with adult’s Still disease treated with tocilizumab  (TCZ) in Israel.

Methods:

 Israeli rheumatologists who have ever treated a patient suffering from adult Still’s disease with TCZ were asked to review their files with special emphasis on the symptoms of the disease (arthralgias/arthritis, fever, sore throat, pleura-pericarditis, hepatitis), number of tender and swollen joints, ESR, CRP and dosage of prednisone at the initiation of TCZ, after 6 months and at the end of follow-up.

Results: : 11 cases were ascertained. All the patients fullfilled the Yamagushi classification criteria for adult Still’s disease: 7 men, aged 33±12, mean duration of disease of 7 years ( range 1-25 years). Until treatment with TCZ, the mean number of disease modifying drugs, including TNFα blockers was 4; 7 out  of 11 have previously failed TNFα blockers. TCZ was administered at a dosage of 8 mg/kg every 4 weeks in 8 patients and every 2 weeks in 3 patients. The mean follow- up was 15 months. All the patients, except 2, completed at least 6 months of treatment . At the start of TCZ treatment, despite a mean prednisone of 31mg±28 mg/d, all the patients reported joint pain; the mean tender and swollen joints count was 12 and 8, respectively. In addition, fever was reported in 7 patients, rash in 5, pleuritis in 3 and hepatitis in 2.The mean ESR and CRP were 65 and 13, respectively. After 6 months of treatment and at the end of follow-up, the number of swollen and tender joints , the ESR and CRP and  the dosage of prednisone decreased significantly (Table 1). At the end of follow up, only 2 patients still complained of mild arthralgias and none reported systemic symptoms.

Conclusion:

TCZ is extremely efficacious in adult Still’s disease. Although randomized controlled studies are needed to confirm this observation, TCZ should be strongly considered in the treatment of patient with adult Still’s disease

 

 

Start of TCZ

After 6 months

End of follow-up

Swollen joints count

8±6

1.25±1.7*

0.7±1.2*

Tender joints count

11.9±7.7

2.25±2*

1.2±0,7*

ESR

65±32

3.4±1.5*

4.3±2.26*

CRP (mg/dl)

13±17

0.47±0.17*

0.46±0.6*

Prednisone dosage (mg/d)

31±28

4.8±3.5*

3.5±5*

  • Mean±SD; p<0.05

Mean; SD

Disclosure:

O. Elkayam,
None;

N. Jiries,
None;

Z. Dranitzki,
None;

S. Kivity,
None;

M. Lidar,
None;

O. Levy,
None;

M. Abu-Shakra,
None;

H. Sarvagil-Maman,
None;

H. Padova,
None;

D. Caspi,
None;

I. Rosner,
None.

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