We are analyzing https://link.springer.com/article/10.1186/s13075-019-1838-6.

Title:
Adult-onset Still’s disease biological treatment strategy may depend on the phenotypic dichotomy | Arthritis Research & Therapy
Description:
Objectives Adult-onset Still’s disease (AOSD) phenotype appears to be dichotomized in systemic or chronic articular forms. As biologicals and particularly interleukin (IL)-1 and IL-6 blockers play a more and more prominent role in the treatment, their place requires clarification. This study aimed to identify factors predictive of treatment response to anakinra or tocilizumab and investigate whether the choice of biotherapy and delays in the initiation of biotherapy influenced the likelihood of steroid discontinuation. Methods A multicenter exploratory retrospective study included all patients diagnosed with AOSD and receiving biological treatments in three regional hospitals until 2018. Clinical and biological characteristics at diagnosis and treatment-related data were collected. The nonparametric Mann-Whitney test was used to perform univariate analysis for quantitative variables, and Fisher’s exact test was used for qualitative variables. Results Twenty-seven patients were included. All but one patient achieved remission with either anakinra or tocilizumab. Treatment responses depended on disease phenotype: the presence of arthritis and a chronic articular phenotype were associated with a substantial response to tocilizumab with p = 0.0009 (OR 36 [2.6–1703]) and p = 0.017 (OR 10 [1.22–92.6]), respectively, whereas the systemic form and the absence of arthritis were associated with a substantial response to anakinra with p = 0.0009 (OR 36 [2.6–1703]) and p = 0.017 (OR 10 [1.22–92.6]), respectively. Tocilizumab increased the likelihood of corticosteroid withdrawal (p = 0.029) regardless of delays in initiation or when it was initiated relative to other treatment in the overall therapeutic strategy. Conclusion This study highlights the therapeutic implications of the phenotypic dichotomy of AOSD and should help us better codify AOSD treatment.
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Keywords {🔍}

disease, patients, tocilizumab, anakinra, treatment, aosd, stills, study, article, adultonset, google, scholar, pubmed, arthritis, form, systemic, chronic, articular, biological, cas, months, response, data, phenotype, clinical, received, corticosteroids, efficacy, withdrawal, refractory, biotherapy, responded, rheumatol, diagnosis, iqr, results, presented, median, adult, likelihood, delay, clin, analysis, initiation, table, stop, fautrel, corticosteroid, therapeutic, phenotypes,

Topics {✒️}

gov/pmc/articles/pmc3390042/ saiki gov/pmc/articles/pmc4616841/ giampietro multiple drug-resistant adult-onset marie-elise truchetet gov/pmc/articles/pmc3437651/ anti-cd20 monoclonal antibody anti-extractable nuclear antigen traditional therapy-resistant adult-onset serra lópez-matencio jm increased c-reactive protein conventional treatment-refractory adult-onset nonparametric mann-whitney test thierry schaeverbeke anti-dna positive article download pdf tumor necrosis factor secure evidence-based medicine targeted therapies macrophage activation syndrome strong steroid-sparing effect clear steroid-sparing effect potential life-threatening complications ear-nose-throat il recent meta-analysis showing label anti-interleukin-1 treatments il-1r inhibitor anakinra service de rhumatologie future large-scale studies nonsteroidal anti-inflammatories reactive hemophagocytic lymphohistiocytosis randomized controlled trial privacy choices/manage cookies treating refractory adult-onset infectious-induced aosd flare anakinra-treated patients group tocilizumab-treated patients group ear-nose-throat gerfaud-valentin creative commons license recent meta-analysis suggested gonzález-gay ma clinical aosd-related characteristics anti-tnf blockers evidence-based review life-threatening conditions arthritis res ther steroid-refractory flares bordeaux teaching hospital bordeaux university hospital long-term therapy

Questions {❓}

How might this impact clinical practice?
Therapeutic innovation in adult-onset Still’s disease (and other rare inflammatory disorders): how to secure evidence-based medicine?
What are the new lines of research suggested by this study?
What is already known about this subject?

Schema {🗺️}

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         description:Adult-onset Still’s disease (AOSD) phenotype appears to be dichotomized in systemic or chronic articular forms. As biologicals and particularly interleukin (IL)-1 and IL-6 blockers play a more and more prominent role in the treatment, their place requires clarification. This study aimed to identify factors predictive of treatment response to anakinra or tocilizumab and investigate whether the choice of biotherapy and delays in the initiation of biotherapy influenced the likelihood of steroid discontinuation. A multicenter exploratory retrospective study included all patients diagnosed with AOSD and receiving biological treatments in three regional hospitals until 2018. Clinical and biological characteristics at diagnosis and treatment-related data were collected. The nonparametric Mann-Whitney test was used to perform univariate analysis for quantitative variables, and Fisher’s exact test was used for qualitative variables. Twenty-seven patients were included. All but one patient achieved remission with either anakinra or tocilizumab. Treatment responses depended on disease phenotype: the presence of arthritis and a chronic articular phenotype were associated with a substantial response to tocilizumab with p = 0.0009 (OR 36 [2.6–1703]) and p = 0.017 (OR 10 [1.22–92.6]), respectively, whereas the systemic form and the absence of arthritis were associated with a substantial response to anakinra with p = 0.0009 (OR 36 [2.6–1703]) and p = 0.017 (OR 10 [1.22–92.6]), respectively. Tocilizumab increased the likelihood of corticosteroid withdrawal (p = 0.029) regardless of delays in initiation or when it was initiated relative to other treatment in the overall therapeutic strategy. This study highlights the therapeutic implications of the phenotypic dichotomy of AOSD and should help us better codify AOSD treatment.
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      name:Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Service de Rhumatologie, Bordeaux, France

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