title: Case report: successful use of short-term add-on tocilizumab for multirefractory systemic flare of adult-onset Still's disease.
abstract: We report on a 64-year-old woman with multirefractory flare of adult-onset Still's disease successfully treated with six-month course of add-on anti-interleukin 6 receptor antibody, tocilizumab. Before administration of tocilizumab, the combination therapy with 80 mg/day of prednisolone and cyclosporine or tacrolimus for five weeks, two courses of pulse methylprednisolone, and high-dose intravenous immunoglobulin could not control the disease. Add-on tocilizumab dramatically improved her disease state and enabled tapering of corticosteroid and tacrolimus. Furthermore remission has been maintained on low-dose corticosteroid and tacrolimus after withdrawal of tocilizumab. This case report suggests that short-term add-on tocilizumab might be a useful therapeutic option for patients with multirefractory flare of polycyclic systemic adult-onset Still's disease.
authors.affiliation: Division of Rheumatology, Nagoya City University Hospital and Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan. tnaniwa@med.nagoya-cu.ac.jp
authors.forename: Taio
authors.initials: T
authors.lastname: Naniwa
authors.forename: Rei
authors.initials: R
authors.lastname: Ito
authors.forename: Maiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Hayami
authors.forename: Shinji
authors.initials: S
authors.lastname: Maeda
authors.forename: Kaneshige
authors.initials: K
authors.lastname: Sasaki
authors.forename: Shiho
authors.initials: S
authors.lastname: Iwagaitsu
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D018432:Drug Resistance, Multiple / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012074:Remission Induction; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D016572:Cyclosporine; D011239:Prednisolone; C502936:tocilizumab; D016559:Tacrolimus; D008775:Methylprednisolone