Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Tocilizumab in Refractory Adult Still's Disease: A Cohort Study.

Puechal,  Xavier, de Bandt,  Michel, Berthelot,  Jean-Marie, Breban,  Maxime, Dubost,  Jean-Jacques, Fain,  Olivier, Kahn,  Jean-Emmanuel


Interleukin-6 (IL-6) is thought to play a role in the pathogenesis of Still's disease. We report the first series of patients with adult Still's disease (ASD) treated with tocilizumab (TCZ), a humanized anti-IL-6 receptor antibody.


To assess the efficacy and tolerance of TCZ in adult patients with refractory ASD.


Cohort study of all patients with ASD treated in France with off-label TCZ between July 2006 and July 2009 and enrolled in a specific French Agency for the Safety of Health Products (AFSSAPS) protocol.

Main Outcome Measures:

European League of Associations for Rheumatology (EULAR) improvement criteria and resolution of systemic symptoms at 3 and 6-month follow-up.


Fourteen patients were included in this study. At the start of TCZ treatment, despite a mean prednisone dose of 23.3 mg/day, mean tender joint count was 10.5/28, swollen joint count was 7.9/28 and mean DAS28 was 5.61. Recurrent systemic involvement, including fever and rash, was present in seven patients. TCZ was administered at 5 to 8 mg/kg every two or four weeks (8 mg/kg/month, n=9). Eleven patients successfully completed the six-month study; one withdrew due to necrotizing angiodermatitis, another due to thoracic oppression at each TCZ infusion and a third due to systemic flare. A good EULAR arthritis response was observed in 64% (9/14) of patients at three months and EULAR arthritis remission in 57% (8/14) at six months. Systemic symptoms were resolved in 86% (6/7) of patients. Moreover, corticosteroid dose was reduced by 56%. No other severe adverse effects occurred.

Figure. Individual disease activity score and mean prednisone dose before and after tocilizumab therapy in adult Still's disease.


In this cohort of patients with intractable refractory ASD, TCZ was effective against systemic involvement of the disease in almost all patients and led to arthritis remission in half the patients, showing a marked corticosteroid-sparing effect and an acceptable tolerance profile. TCZ is a promising new treatment for ASD.

To cite this abstract, please use the following information:
Puechal, Xavier, de Bandt, Michel, Berthelot, Jean-Marie, Breban, Maxime, Dubost, Jean-Jacques, Fain, Olivier, et al; Tocilizumab in Refractory Adult Still's Disease: A Cohort Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :701
DOI: 10.1002/art.28469

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