Interleukin-1 receptor antagonist (anakinra) treatment in patients with systemic-onset juvenile idiopathic arthritis or adult onset Still disease: preliminary experience in France.
BACKGROUND
Anakinra treatment has been reported to be effective in some patients with systemic-onset juvenile idiopathic arthritis (SoJIA) or adult-onset Still disease (AoSD).


OBJECTIVE
To assess the efficacy and the safety of anakinra treatment in SoJIA and AoSD.


METHODS
SoJIA and AoSD patients were treated with anakinra (1-2 mg/kg/day in children, 100 mg/day in adults); we analysed its effect on fever, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, numbers of swollen and tender joints, the assessment of disease activity (by physician and parent/patient) and pain (by parent/patient), and American College of Rheumatology (ACR) pediatric core set criteria for JIA activity.


RESULTS
A total of 35 patients were included, 20 with SoJIA and 15 with AoSD. Their mean age (range) at the onset of treatment was 12.4 (3-23) and 38.1 (22-62) years, respectively; disease duration was 7.0 (1-16) and 7.8 (2-27) years, respectively. Active arthritis was present in all cases but one. Of the 20 SoJIA patients, 5 achieved ACR 50% improvement in symptoms (ACR50) response criteria at 6 months. Steroid dose had been decreased by 15% to 78% in 10 cases. A total of 11 of the 15 AoSD patients achieved at least a 50% improvement for all disease markers (mean follow-up: 17.5 (11-27) months). Steroids had been stopped in two cases and the dose was decreased by 45% to 95% in 12 patients. Two patients stopped anakinra due to severe skin reaction, and two patients due to infection: one visceral leishmaniasis and one varicella.


CONCLUSIONS
Anakinra was effective in most AoSD patients, but less than half SoJIA patients achieved a marked and sustained improvement.
Lequerré
T
T
Rheumatology Department, Rouen University Hospital & Inserm 905, 76031 Rouen, France. thierry.lequerre@univ-rouen.fr
Quartier
P
P
Rosellini
D
D
Alaoui
F
F
De Bandt
M
M
Mejjad
O
O
Kone-Paut
I
I
Michel
M
M
Dernis
E
E
Khellaf
M
M
Limal
N
N
Job-Deslandre
C
C
Fautrel
B
B
Le Loët
X
X
Sibilia
J
J
D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000097:blood / Q000188:drug therapy*; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D012720:Severity of Illness Index; D016706:Still's Disease, Adult-Onset / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D017472:Receptors, Interleukin-1; D002097:C-Reactive Protein