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Abstract
Background We previously reported on treatment of refractory Adult-onset Still's disease (AOSD) with tocilizumab (TCZ) and how it enables rapid reduction of steroid dose.
Objectives The present study focuses on a new aspect, namely, how TCZ inhibits recurrence and enables discontinuation of steroids in AOSD.
Methods In 15 subjects, including 7 who received TCZ combination therapy, treatment outcomes of steroid monotherapy and therapy with TCZ were compared. Rates of recurrence were compared using the Kaplan-Meier method.
Results The mean age of onset was 46.7±23.4 years and the mean disease duration was 10.0±6.5 years. Mean CRP at onset and ferritin levels were higher when patients were receiving TCZ (CRP: 20.79±8.10 mg/dl, ferritin: 17872.2±12158.9 ng/ml) relative to when patients were not receiving TCZ (CRP: 10.79±8.48 mg/dl, ferritin: 7352.3±6837.5 ng/ml). In all patients, with the exception of one patient receiving infliximab, TCZ was administered after their condition was calmed down using a high dose of steroid (60-120 mg prednisolone [PSL]). After TCZ was started, CRP decreased from 0.88±1.14 mg/dl to 0.02±0.02 mg/dl and ferritin decreased from 3153.0±6865.0 ng/dl to 21.16±25.4 ng/dl (P=0.02). The steroid dose was rapidly reduced after TCZ was started, and reduction to a 20 mg dose of PSL was achieved an average of 65.8±26.9 (range: 31-109) days after the start of the maximum dose. The average final steroid (PSL) dose during remission maintenance after initiation of TCZ was 1.2±1.6 mg/day, and 4 patients were able to discontinue steroid use. In addition, it was possible to extend the interval of TCZ administration to an average of 6.1±2.1 weeks. Recurrence was not noted in 6 patients, and there was a total of 17 recurrent episodes. The rate of non-recurrence was significantly higher after initiation of TCZ (n=7) than during the overall period including the time before initiation (n=17) (100% vs 49.9%)(P=0.04).
Conclusions TCZ is useful in treatment to induce and maintain remission in patients who have AOSD with strong disease activity. TCZ enables discontinuation of steroid use and extension of the interval of TCZ administration during remission maintenance and also inhibits recurrence.
Disclosure of Interest None declared