Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Adult-onset Still’s disease (AOSD) is frequently refractory to standard immunosuppressive drugs and it may require biological therapy. Tocilizumab (TCZ) has demonstrated efficacy in clinical isolated cases or in small series. We assessed the efficacy of TCZ in AOSD.
Methods:
Multicenter study of 32 patients with AOSD from 20 hospitals diagnosed according to Yamagouchi’s criteria (J Rheumatol 1992; 19:424). TCZ was used due to lack of efficacy to standard synthetic immunosuppressive drugs or lack of adequate response to at least 1 biologic agent.
Results:
The 32 patients (24 women/ 8 men), had a mean age of 37.9±16.4 (range 16-74) and an average duration of AOSD of 5.6±5.0 years (range 0.1-17) before TCZ onset. In addition to steroids, they had previously received the following drugs: Methotrexate (29 patients), Anakinra (14), Etanercept (7), Adalimumab (6) and Infliximab (4). TCZ standard dose was 8 mg/k/iv/4 weeks.
At TCZ onset, the most frequent manifestations were joint (31 cases), cutaneous (17) and fever (19), along with increase of ESR or CRP (25 cases), anemia (14) or leucocytosis (18). Following TCZ clinical and analytical response was observed from the beginning (1st month) that was maintained over time (TABLE).
After a mean follow-up of 18.4 ±12.5 months, skin manifestations disappeared in 16 of 17 of the patients (94.1%), fever in 18 of 19 (94.7%) and joint manifestations in 25 of 31 (80.6%). In the laboratory findings, there was also improvement in most cases with normalization of the leucocytosis in 11 of 18 (61.1%) patients, anemia in 13 of 14 (92.9%), ESR in 18 of 24 (75 % ), CRP in 22 of 25 (88%), hepatic enzymes (AST/ALT) in 3 of 4 (75 %) and ferritin seric levels in 11 of 14 (78.6%). The median [IQR] dose of prednisone was reduced from 15.1 [7.5-20] to 6.1 [0.0-7.5] mg/day.
Conclusion:
In refractory AOSD, TCZ yields early and maintained clinical-laboratory improvement, even in cases that are refractory to other biologic agents. Although TCZ shows global efficacy, joint manifestations are more refractory than systemic manifestations.
|
Basal |
Month 1 |
Month 3 |
Month 6 |
Month 12 |
|
|
Joint manifestations, % |
96.9% | 68.8% | 43.8% | 25% | 31.3% |
|
Fever, % |
59.4% | 6.3% | 6.3% | 3.1% | 3.1% |
|
Cutaneous manifestations, % |
53.1% | 15.6% | 12.5% | 6.3% | 6.3% |
|
Leukocyte/mm3, mean ±SD |
13650± 5978.4 | 8709 ± 4242.2 | 7898 ± 4188.7 | 7364 ± 3384.5 | 8630 ± 3709.5 |
|
ESR, mean±SD (mm/1st/hour) |
49.8 ± 18,1 | 8.8 ± 10.8 | 5.9 ± 5.3 | 6.2 ± 5.7 | 8.0 ± 9.5 |
|
CRP, mg/dL mean±SD |
23.2 ± 35.8 | 3.1 ± 6.0 | 0.8 ± 2.1 | 0.9 ± 2.7 | 0.8 ± 1.6 |
|
Prednisone dosage, mean±SD |
15.2 ± 0.3 | 9.3 ± 7.0 | 6.0 ± 5.1 | 4.5 ± 5.4 | 4.8 ± 8.2 |
|
Prednisone dosage, median [IQR] |
12.5 [7.5-20] | 7.5 [5-15] | 5 [2.5-10] | 2.5 [0-7.5] | 1.3 [0-7.5] |
Disclosure:
F. Ortiz-Sanjuan,
None;
R. Blanco,
None;
J. Narvaez,
None;
E. Rubio Romero,
None;
A. Olivé,
None;
S. Castañeda,
None;
A. Gallego Flores,
None;
M. V. Hernández,
None;
C. Mata,
None;
I. Ros Vilamajo,
None;
A. Sifuentes Giraldo,
None;
M. Caracuel,
None;
M. Freire,
None;
C. Gómez Arango,
None;
J. Llobet,
None;
S. Manrique Arija,
None;
C. Marras,
None;
C. Moll Tuduri,
None;
C. Plasencia Rodriguez,
None;
R. Roselló,
None;
A. Urruticoechea,
None;
M. L. Velloso Feijoo,
None;
J. Loricera,
None;
V. Calvo-Rio,
None;
M. A. González-Gay,
None.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-tocilizumab-in-refractory-adult-onset-stills-disease-multicenter-study-of-32-patients/