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.


Long Term Treatment with Anakinra in Patients with Adult-Onset Still Disease.

Cecilia1,  Giampietro, Meriem2,  Ridene, Bruno3,  Fautrel, Pierre3,  Bourgeois

University of L'Aquila, L'Aquila, Italy
University of Tunis, Tunis, Tunisia
University Paris 6–Pierre et Marie Curie University; Rheumatology, Pitie-Salpêtriere Hospital, Paris, France

Background:

Adult-onset Still disease (AOSD) is a rare systemic inflammatory disorder. Aetiology is still unknown, however recent advances suggest IL-1 to play a pivotal role in his pathogenesis.

Several observations have demonstrated the rapid efficacy of the anti-IL1 receptor antagonist anakinra in refractory cases treatment, but other studies are needed to evaluate his long term effects.

Objective:

To assess the long term efficacy and safety of anakinra treatment in patients with AOSD.

Methods:

Patients were identified by their participation to a precedent study and by a survey conducted in the CRI website.

19 patients affected by AOSD as defined by Yamaguchi diagnostic criteria and treated with anakinra were recruited contacting by mail all departements of rheumatology and internal medicine in France. Medical informations were retrospectively collected using a standardised questionnaire.Anakinra was given subcutaneusly at a daily dose of 100mg.

Patients were classified at remission if all symtoms of AOSD were disappeared, partial response if some general or articular signs persisted and failure if no response were observed.

Results:

Patients were mean aged 40.6 ± 11.5 years (range 23 to 73), with mean disease duration at anakinra start of 9.4 years. Clinical expression was predominantely systemic in 6 patients and polyarticular in 13. All patients have previously failed to corticosteroids, synthetic DMARDs and for 10 of them to anti-TNFa and anti-CD20.

Anakinra was well tolerated in patients with AOSD and adverse events were rated as mild. The most common adverse event observed was a rash at the site of injection. It motived treatment discontinuation in only 1 patient. No augmentation of infection rate was observed.

At a mean follow up of 30.7 months, complete remission occurred in 13 cases. Partial response was observed in 4 cases. The symptoms that persisted were mainly articular manifestation whereas systemic ones disappeared early in the cours of treatment. 2 patients experienced a loss of efficacy after a mean of 15 months.

Anakinra allowed corticosteroid sparing and reduction of dose of eventually associated DMARDs. At the last visit, 4 patients withdrawn treatment because remission has been obtained and reduction of anakinra dose was possible in 4 cases without observed relapse of disease.

Evolution in Long-term Follow-up

Complete remission (n = 13) (68.4%)Anakinra discontinued without relapse (n = 4) (21%)
 Dose reduction without relapse (n = 4) (21%):
 - 1 subcutaneous injection 3 time a week (n = 1)
 -1 subcutaneous injection 2 time a week (n = 2)
 - 1 subcutaneous injection 6 time a week (n = 1)
 Same dose continued (n = 5) (26.3%)
Partial responseDesappearance of systemic manifestations
(n = 4) (21%)Persistence of articular manifestations
Loss of efficacy (n = 2) (10.5%)Switch to anti-IL6 (1 infusion/4 weeks) with remission

Conclusion:

AOSD patients experience a drastic response to Anakinra. In our long term study this efficacy is maintained without relapse or serius side effects.

To cite this abstract, please use the following information:
Cecilia, Giampietro, Meriem, Ridene, Bruno, Fautrel, Pierre, Bourgeois; Long Term Treatment with Anakinra in Patients with Adult-Onset Still Disease. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :902
DOI: 10.1002/art.28670

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