Background Adult onset Still’s disease (AOSD) is a systemic inflammatory disorder with unknown etiology. As therapeutic agents, traditional disease modifying anti-rheumatic drugs (DMARDs) or biological agents are suggested for patients unresponsive to corticosteroid. Among important cytokines for the AOSD pathogenesis, IL-6 plays a pivotal role. Several case reports have suggested that tocilizumab, a humanized anti-interleukin (IL)-6 receptor antibody was effective for intractable AOSD.
Objectives Here, we described the clinical course of refractory Korean patients treated with tocilizumab therapy.
Methods The 8 patients who were refractory to DMARDs and/or etarnecept or dependent to corticosteroid were enrolled for tocilizumab therapy after informed contents. Tocilizumab at 8mg/kg was administered every 4 weeks.
Results Six females and 2 males were treated with tocilizumab. The mean age was 33.8 (26-47) years old. The frequency of tocilizumab therapy was an average of 6.3 (2-13) times. Almost patients showed complete (50.0%) or partial (37.5%) response to tocilizumab therapy except one patient (Table 1). The clinical symptoms improved in 4 weeks (mean), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) improved in 6.3 weeks, respectively. Serum ferritin, IL-18 and IL-6 levels slowly improved within 9.3 weeks, 12.5 weeks and 9.3 weeks, respectively. Three patients discontinued tocilizumab therapy although they showed improvement of clinical symptoms; because of severe headache and chest discomfort at 12 weeks, neutropenia at 8 weeks, and severe hepatotoxicity at 8 weeks, respectively. Other adverse events such as mild dizziness, hair loss, weight gain and transient leucopenia were observed and those were tolerable during follow-up.
Conclusions Tocilizumab could be a new therapeutic option for AOSD patients refractory to conventional therapy. However, further clinical trials for efficacy and safety of tocilizumab in patients with AOSD are needed.
Disclosure of Interest None Declared