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Tocilizumab in refractory adult Still's disease
Author(s) -
Puéchal Xavier,
DeBandt Michel,
Berthelot JeanMarie,
Breban Maxime,
Dubost JeanJacques,
Fain Olivier,
Kahn JeanEmmanuel,
Lequen Laurence,
LongyBoursier Maïté,
Perdriger Aleth,
Schaeverbeke Thierry,
Toussirot Eric,
Sibilia Jean
Publication year - 2011
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20319
Subject(s) - medicine , tocilizumab , refractory (planetary science) , rheumatism , rash , prednisone , cohort , gastroenterology , surgery , disease , physics , astrobiology
Objective There is an unmet need for the treatment of adult Still's disease (ASD), the pathogenesis of which may involve interleukin‐6 (IL‐6). We report the first series of patients with ASD treated with tocilizumab (TCZ), a humanized anti–IL‐6 receptor antibody. Methods All ASD patients treated with TCZ in France between July 2006 and July 2009 after failure to all available therapies were included in this cohort study. The main outcome measures were the European League Against Rheumatism (EULAR) improvement criteria and resolution of systemic symptoms at the 3‐ and 6‐month followup periods. Results Fourteen patients with refractory ASD were included. At the start of TCZ treatment, despite a mean prednisone dosage of 23.3 mg/day, based on a 28‐joint count, mean tender joints were 10.5, mean swollen joints were 7.9, and the mean Disease Activity Score in 28 joints was 5.61. Recurrent systemic involvement, including fever and rash, was present in 7 patients. TCZ was administered at 5–8 mg/kg every 2 or 4 weeks (8 mg/kg/month, n = 9). Eleven patients successfully completed the 6‐month study; 1 withdrew due to necrotizing angiodermatitis, another due to chest pain at each TCZ infusion, and a third due to systemic flare. A good EULAR response was observed in 64% of patients (9 of 14) at 3 months and EULAR remission was observed in 57% (8 of 14) at 6 months. Systemic symptoms were resolved in 86% of patients (6 of 7). Moreover, corticosteroid dose was reduced by 56%. No other severe adverse effects occurred. Conclusion TCZ is a promising new treatment for ASD.