RT Journal Article
SR Electronic
T1 Tocilizumab in Adult-onset Still’s Disease: the Israeli Experience
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 244
OP 247
DO 10.3899/jrheum.130881
VO 41
IS 2
A1 Ori Elkayam
A1 Nizar Jiries
A1 Zvi Dranitzki
A1 Shay Kivity
A1 Merav Lidar
A1 Ofer Levy
A1 Jacob Ablin
A1 Mahmoud Abu-Shakra
A1 Hagit Savargyl-Maman
A1 Hagit Padova
A1 Dan Caspi
A1 Itzhak Rosner
YR 2014
UL http://www.jrheum.org/content/41/2/244.abstract
AB Objective. To describe the Israeli experience of treating adult-onset Still’s disease (AOSD) with tocilizumab (TCZ). Methods. Israeli rheumatologists who treated AOSD with TCZ filled in questionnaires on symptoms, number of tender and swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and dosage of prednisone at initial TCZ administration, after 6 months, and at the end of followup. Results. Nine male and 6 female patients, aged 33 ± 12 years, mean disease duration 9 years (range: 1–25) were identified. They had used a mean of 3.6 disease-modifying drugs, including 10 patients with tumor necrosis factor blockers. Intravenous TCZ 8 mg/kg was administered every 4 weeks (12 patients) or every 2 weeks (3 patients). All patients completed at least 6 months of treatment. The mean followup period was 15.7 ± 9 months. At the onset of therapy, despite the use of prednisone (27.6 ± 26.3 mg/d), all patients reported joint pain. Fever was reported in 9 patients, rash in 7, pleuritis in 3, and hepatitis in 2 before TCZ use, with mean ESR and CRP levels of 60 ± 28 mm/h and 11.6 ± 15 mg/dl, respectively. After 6 months of treatment and at the end of followup, the number of tender and swollen joints, the ESR and CRP levels, and the prednisone dosage decreased significantly. Only 2 patients still complained of mild arthralgias, and none reported systemic symptoms at the end of followup. Conclusion. TCZ 8 mg/kg was extremely efficacious in treating adult patients with refractory Still’s disease. Both TCZ and interleukin 1 blockade should be considered in the treatment algorithm of AOSD. Randomized controlled studies are needed to validate these findings.