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Title:
The effectiveness of tocilizumab in treating refractory adult-onset Still’s disease with dichotomous phenotypes: IL-18 is a potential predictor of therapeutic response | Clinical Rheumatology
Description:
Objective Adult-onset Still’s disease (AOSD) is a systemic inflammatory disorder with clinical heterogeneity. Although tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, is an effective treatment for AOSD, the evidence regarding its efficacy on systemic or articular subtypes is conflicting. Furthermore, the predictors of therapeutic response are still elusive and worthy of exploration. Methods This two-center retrospective study analyzed the effectiveness and safety profile of TCZ treatment in 28 patients with refractory AOSD. The 28-joint disease activity score (DAS28) and systemic activity score were assessed before and during TCZ treatment period at weeks 12, 24, 36, and 48. Plasma levels of proinflammatory cytokines at baseline were determined using ELISA method. Results Among the systemic subtype patients, 10 (58.8%), 13 (76.5%), 14 (82.4%), and 15 (88.2%) patients achieved complete remission at week 12, 24, 36, and 48, respectively, in comparison to 2 (22.2%), 5 (55.6%), 6 (66.7%), and 7 (77.8%) who achieved disease remission (DAS28 < 2.6) at weeks 12, 24, 36, and 48, respectively, among articular subtype patients. The systemic activity scores and inflammatory parameters were significantly decreased after 12-week TCZ therapy, and TCZ could significantly reduce corticosteroid dose in AOSD patients. Multivariate analysis reveals that baseline IL-18 level is a significant predictor of poor therapeutic response at week 24 (odds ratio 7.86, p < 0.05). Conclusion AOSD patients refractory to high-dose corticosteroids and methotrexate may respond well to TCZ treatment with a steroid-sparing effect and an acceptable safety. A high baseline IL-18 level may be a predictor of poor therapeutic response. Key Points • Tocilizumab may be effective and well-tolerated in refractory AOSD patients regardless of disease subtypes. • High plasma levels of IL-18 may predict poor response to tocilizumab in AOSD patients.
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disease, article, stills, google, scholar, pubmed, adultonset, cas, tocilizumab, chen, rheumatol, patients, treatment, clinical, refractory, arthritis, study, clin, taichung, data, taiwan, analysis, httpsdoiorg, aosd, interleukin, response, hsieh, activity, therapy, adult, httpsdoiorgs, medicine, rheumatology, therapeutic, tang, deryuan, systemic, tcz, efficacy, retrospective, access, syndrome, rheum, mod, university, privacy, cookies, content, information, treating,
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month download article/chapter multiple drug-resistant adult-onset der-yuan chen traditional therapy-resistant adult-onset c-wh contributed equally yi-ming chen gov/protocoldevelopment/electronic_applications/ctc hsin-hua chen conventional treatment-refractory adult-onset strobe-compliant article shih-hsin chang single-center observational study chia-wei hsieh treating refractory adult-onset full article pdf privacy choices/manage cookies national cancer institute china medical university jung jy macrophage activation syndrome macrophage-activation syndrome article tang initial conventional treatments high-dose corticosteroids serum cytokine profiles single centre experience lan jl gonzalez-gay ma systemic activity score systemic activity scores yoo dh single-center study multicentre retrospective study van leeuwen ma multicenter retrospective analysis european economic area po-hao huang international task force shiow-jiuan wey biostatistics task force ethics declarations disclosures predict poor response additional information publisher' arthritis care res refractory adult onset refractory adult-onset large multicenter cohort van riel pl medical research conditions privacy policy
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headline:The effectiveness of tocilizumab in treating refractory adult-onset Still’s disease with dichotomous phenotypes: IL-18 is a potential predictor of therapeutic response
description:Adult-onset Still’s disease (AOSD) is a systemic inflammatory disorder with clinical heterogeneity. Although tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, is an effective treatment for AOSD, the evidence regarding its efficacy on systemic or articular subtypes is conflicting. Furthermore, the predictors of therapeutic response are still elusive and worthy of exploration. This two-center retrospective study analyzed the effectiveness and safety profile of TCZ treatment in 28 patients with refractory AOSD. The 28-joint disease activity score (DAS28) and systemic activity score were assessed before and during TCZ treatment period at weeks 12, 24, 36, and 48. Plasma levels of proinflammatory cytokines at baseline were determined using ELISA method. Among the systemic subtype patients, 10 (58.8%), 13 (76.5%), 14 (82.4%), and 15 (88.2%) patients achieved complete remission at week 12, 24, 36, and 48, respectively, in comparison to 2 (22.2%), 5 (55.6%), 6 (66.7%), and 7 (77.8%) who achieved disease remission (DAS28 < 2.6) at weeks 12, 24, 36, and 48, respectively, among articular subtype patients. The systemic activity scores and inflammatory parameters were significantly decreased after 12-week TCZ therapy, and TCZ could significantly reduce corticosteroid dose in AOSD patients. Multivariate analysis reveals that baseline IL-18 level is a significant predictor of poor therapeutic response at week 24 (odds ratio 7.86, p < 0.05). AOSD patients refractory to high-dose corticosteroids and methotrexate may respond well to TCZ treatment with a steroid-sparing effect and an acceptable safety. A high baseline IL-18 level may be a predictor of poor therapeutic response.
datePublished:2021-09-17T00:00:00Z
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Adult-onset Still’s disease
Effectiveness
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Therapy
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Rheumatology
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headline:The effectiveness of tocilizumab in treating refractory adult-onset Still’s disease with dichotomous phenotypes: IL-18 is a potential predictor of therapeutic response
description:Adult-onset Still’s disease (AOSD) is a systemic inflammatory disorder with clinical heterogeneity. Although tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, is an effective treatment for AOSD, the evidence regarding its efficacy on systemic or articular subtypes is conflicting. Furthermore, the predictors of therapeutic response are still elusive and worthy of exploration. This two-center retrospective study analyzed the effectiveness and safety profile of TCZ treatment in 28 patients with refractory AOSD. The 28-joint disease activity score (DAS28) and systemic activity score were assessed before and during TCZ treatment period at weeks 12, 24, 36, and 48. Plasma levels of proinflammatory cytokines at baseline were determined using ELISA method. Among the systemic subtype patients, 10 (58.8%), 13 (76.5%), 14 (82.4%), and 15 (88.2%) patients achieved complete remission at week 12, 24, 36, and 48, respectively, in comparison to 2 (22.2%), 5 (55.6%), 6 (66.7%), and 7 (77.8%) who achieved disease remission (DAS28 < 2.6) at weeks 12, 24, 36, and 48, respectively, among articular subtype patients. The systemic activity scores and inflammatory parameters were significantly decreased after 12-week TCZ therapy, and TCZ could significantly reduce corticosteroid dose in AOSD patients. Multivariate analysis reveals that baseline IL-18 level is a significant predictor of poor therapeutic response at week 24 (odds ratio 7.86, p < 0.05). AOSD patients refractory to high-dose corticosteroids and methotrexate may respond well to TCZ treatment with a steroid-sparing effect and an acceptable safety. A high baseline IL-18 level may be a predictor of poor therapeutic response.
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name:Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
name:Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
name:Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
name:Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
name:Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
name:Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
name:Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
name:Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
name:Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
name:Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
name:College of Medicine, China Medical University, Taichung, Taiwan
name:Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
name:College of Medicine, China Medical University, Taichung, Taiwan
name:Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
name:College of Medicine, China Medical University, Taichung, Taiwan
name:Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
name:Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
name:College of Medicine, China Medical University, Taichung, Taiwan
name:Translational Medicine Laboratory, Rheumatology and Immunology Center, Taichung, Taiwan
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