Anakinra spectacular in adult-onset Still's disease

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Anakinra " spectacular " in adult-onset Still's disease

Rheumawire

Jul 6, 2004

Zosia Chustecka

Berlin, Germany - Two separate groups of researchers have reported cases

in which patients with recalcitrant adult-onset Still's disease (AOSD)

showed a prompt response to treatment with the interleukin-1 blocker

anakinra (Kineret, Amgen). Both groups described their findings in

poster presentations at the recent EULAR 2004 meeting [1, 2].

Dr Boulos Haraoui (Montreal University Hospital, QC) and colleagues

reported 3 cases involving patients with refractory chronic AOSD

requiring high maintenance doses of corticosteroids as well as

immunosuppressive agents. The response to anakinra was " spectacular,

with improvement seen within the first few days of initiation of

therapy, " they said. " More important, anakinra allowed us for the first

time to significantly taper the dose of prednisolone while maintaining

excellent control of the disease. "

Of the 3 patients, 2 became completely asymptomatic after 4 and 5 months

of anakinra 100 mg daily, respectively. One of these patients is still

taking prednisone, but the dose has been reduced, while the other

stopped prednisone and takes occasional indomethacin and regular

methotrexate.

The third patient also responded well to anakinra, and systemic symptoms

completely subsided after 6 months of therapy, but she continues to have

a low-grade smoldering synovitis, which is managed with 10-mg prednisone

and 150-mg azathioprine. This patient had been diagnosed with AOSD 11

years ago and had previously tried and failed over time to respond to

methotrexate, azathioprine, leflunomide, infliximab, etanercept, and

plasmapheresis. Prednisone could never be tapered below 30 mg per day,

said the researchers. At the time when anakinra was started, she was on

prednisone 40 mg and cyclophosphamide 50 mg per day.

Haraoui et al comment that anakinra was " very well tolerated. " None of

the patients experienced major side effects and only 1 patient had

moderate to severe injection-site reactions, which subsided after about

8 weeks of therapy. They conclude: " Anakinra should be considered early

in the management of AOSD requiring high doses of prednisone and not

responding to standard [disease-modifying antirheumatic drugs] DMARDs. "

Separately, another 2 cases were reported by Dr Aelion and Dr

Satish Odhav (University of Tennessee, ). Both of these patients

responded promptly to treatment with anakinra, with fever resolving and

joint pain improving within days in 1 patient and a significant

improvement seen within a few weeks in the other. One of the patients is

now continuing on anakinra 100 mg/day alone, with no recurrence and with

normal laboratory values, and has returned to work as a nurse. The other

patient has been weaned of corticosteroids and remains stable on the

standard dose of anakinra and with oral methotrexate 10 mg once a week.

Anakinra may offer a " viable alternative to high-dose steroids and

cytotoxic therapy, " and its use in AOSD merits further study in

prospective clinical trials, the researchers commented.

Sources

Haraoui B, Bourrelle D, Kaminska E. Anakinra in the

treatment of adult onset Still's disease. Presented at: EULAR 2004;

Berlin, Germany; June 9-12, 2004. Abstract FRI0148.

Aelion JA and Odhav SK. Prompt response to treatment

with anakinra in adult onset Still's disease. Presented at: EULAR 2004;

Berlin, Germany; June 9-12, 2004. Abstract FRI0109.

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org