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Background:   Despite being burdened by significant adverse events, glucocorticoids (GCs) are frequently employed in managing adult onset Still’s disease (AOSD), prompting the need for GC-sparing agents. In this work, we performed a systematic review and meta-analysis to synthesize the evidence about the reduction of concomitant GCs dosage and the rate of GCs discontinuation in patients with AOSD who were treated with anakinra, a recombinant IL-1 receptor antagonist.Methods:   A systematic review of the literature was completed to identify all available data concerning the reduction of concomitant GCs dosage following anakinra in AOSD and a meta-analysis was thus performed using a random-effects model.Results:   A significant reduction of the GCs dosage was detected by pooled analysis with mean difference of –22.4 mg/day [95% confidence interval (CI): –28.8 to –16.1, p &lt; 0.0001] at the last follow-up; the heterogeneity was moderate (Q = 11.67 with df = 7.00, p &lt; 0.0001, I 2  = 40.01%). Furthermore, the pooled analysis under a random effects model showed an overall rate of GCs discontinuation of 0.35 (95% CI: 0.28–0.41, p &lt; 0.0001); the heterogeneity was low (Q = 5.99 with df = 6.00, p &lt; 0.0001, I 2  = 0.00%).Discussion:   Taking together all these findings, the reduction of concomitant GCs dosage following anakinra could be suggested, leading to a further improvement of AOSD therapeutic strategy.Conclusion:   In conclusion, the present systematic review and meta-analysis suggests the reduction of concomitant GCs dosage following treatment with anakinra. A percentage of patients are no longer required to be treated with GCs, discontinuing these drugs without a flare of the disease.

therapeutic advances in musculoskeletal disease

The reduction of concomitant glucocorticoids dosage following treatment with IL-1 receptor antagonist in adult onset Still’s disease. A systematic review and meta-analysis of observational studies