title: Tocilizumab in adult-onset Still's disease: the Israeli experience.
abstract: OBJECTIVE
  To describe the Israeli experience of treating adult-onset Still's disease (AOSD) with tocilizumab (TCZ).
  
  
  METHODS
  Israeli rheumatologists who treated AOSD with TCZ filled in questionnaires on symptoms, number of tender and swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and dosage of prednisone at initial TCZ administration, after 6 months, and at the end of followup.
  
  
  RESULTS
  Nine male and 6 female patients, aged 33 ± 12 years, mean disease duration 9 years (range: 1-25) were identified. They had used a mean of 3.6 disease-modifying drugs, including 10 patients with tumor necrosis factor blockers. Intravenous TCZ 8 mg/kg was administered every 4 weeks (12 patients) or every 2 weeks (3 patients). All patients completed at least 6 months of treatment. The mean followup period was 15.7 ± 9 months. At the onset of therapy, despite the use of prednisone (27.6 ± 26.3 mg/d), all patients reported joint pain. Fever was reported in 9 patients, rash in 7, pleuritis in 3, and hepatitis in 2 before TCZ use, with mean ESR and CRP levels of 60 ± 28 mm/h and 11.6 ± 15 mg/dl, respectively. After 6 months of treatment and at the end of followup, the number of tender and swollen joints, the ESR and CRP levels, and the prednisone dosage decreased significantly. Only 2 patients still complained of mild arthralgias, and none reported systemic symptoms at the end of followup.
  
  
  CONCLUSIONS
  TCZ 8 mg/kg was extremely efficacious in treating adult patients with refractory Still's disease. Both TCZ and interleukin 1 blockade should be considered in the treatment algorithm of AOSD. Randomized controlled studies are needed to validate these findings.
authors.affiliation: From the Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Rheumatology, Bnai Zion Medical Center, Haifa; Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem; Rheumatology Unit, The Chaim Sheba Medical Center, Tel Hashomer; Rheumatology Unit, Assaf Harofe Medical Center; Rheumatology Unit, Soroka Medical Center, Beer Sheva, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Elkayam
authors.forename: Nizar
authors.initials: N
authors.lastname: Jiries
authors.forename: Zvi
authors.initials: Z
authors.lastname: Dranitzki
authors.forename: Shay
authors.initials: S
authors.lastname: Kivity
authors.forename: Merav
authors.initials: M
authors.lastname: Lidar
authors.forename: Ofer
authors.initials: O
authors.lastname: Levy
authors.forename: Jacob
authors.initials: J
authors.lastname: Ablin
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abu-Shakra
authors.forename: Hagit
authors.initials: H
authors.lastname: Savargyl-Maman
authors.forename: Hagit
authors.initials: H
authors.lastname: Padova
authors.forename: Dan
authors.initials: D
authors.lastname: Caspi
authors.forename: Itzhak
authors.initials: I
authors.lastname: Rosner
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab; D011241:Prednisone
keywords: ADULT-ONSET STILL’S DISEASE; BIOLOGICS; CYTOKINES; DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; INFLAMMATION