Efficacy of Anakinra in Refractory Adult-Onset Still's Disease: Multicenter Study of 41 Patients and Literature Review
Ortiz Sanjuán, Francisco (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Blanco, Ricardo (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Riancho Zarrabeitia, Leyre (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Castañeda, Santos (Hospital Universitario de la Princesa (Madrid))
Olivé Marqués, Alejandro (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Riveros, Anne (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Velloso Feijoo, María L. (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Narváez, Javier (Hospital Universitari de Bellvitge)
Jiménez Moleón, Inmaculada (Hospital Universitario San Cecilio (Granada))
Maiz Alonso, Olga (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Ordóñez, Carmen (Hospital Regional Universitario de Málaga)
Bernal-Vidal, José Antonio (Hospital General Universitario de Alicante (Alacant, País Valencià))
Hernández, María V. (Hospital Clínic i Provincial de Barcelona)
Sifuentes Giraldo, Walter A. (Hospital Universitario Ramón y Cajal (Madrid))
Gómez Arango, Catalina (Hospital de Basurto (Bilbao, Biscaia))
Galíndez Agirregoikoa, Eva (Hospital de Basurto (Bilbao, Biscaia))
Blanco-Madrigal, J.M (Hospital de Basurto (Bilbao, Biscaia))
Ortiz Santamaría, Vera (Hospital General de Granollers)
Blanco Barnusell, Jordi del (Hospital Sant Jaume de Calella (Barcelona))
Dios, Juan R. de (Arabako Unibertsitate Ospitalea (Vitoria, País Basc))
Moreno Martínez-Losa, Mireia (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Fiter, Jordi (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Riscos, Marina de los (Hospital Universitario 12 de Octubre (Madrid))
Carreira, Patricia E (Hospital Universitario 12 de Octubre (Madrid))
Rodriguez Valls, María J. (Hospital Universitario de Jerez (Jerez de la Frontera))
González Vela, M. Carmen (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Calvo-Río, Vanesa (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Loricera, Javier (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Palmou Fontana, Natalia (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Pina, Trinitario (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Llorca, Javier (Instituto de Investigación Sanitaria Valdecilla (Santander, Cantàbria))
Gonzalez-Gay, MA (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))

Date:	2015
Abstract:	Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients. Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent. Forty-one patients (26 women/15 men) were recruited. They had a mean age of 34. 4 ± 14 years and a median [interquartile range (IQR)] AOSD duration of 3. 5 [2-6] years before ANK onset. At that time the most common clinical features were joint manifestations 87. 8%, fever 78%, and cutaneous rash 58. 5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41. 5% and to 7. 3% respectively, fever from 78% to 14. 6%, anemia from 56. 1% to 9. 8%, and lymphadenopathy from 26. 8% to 4. 9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11. 3-47. 5] mg/day at ANK onset to 5 [0-10] at 12 months. After a median [IQR] follow-up of 16 [5-50] months, the most important side effects were cutaneous manifestations (n = 8), mild leukopenia (n = 3), myopathy (n = 1), and infections (n = 5). ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Artritis reumatoide ; Adult-Onset Still's Disease ; AOSD ; Anakinra
Published in:	Medicine, Vol. 94 Núm. 39 (september 2015) , ISSN 1536-5964

DOI: 10.1097/MD.0000000000001554
PMID: 26426623

8 p, 278.6 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles