Successful Use of Higher-Dose Etanercept for Multirefractory Systemic Flare of Adult-Onset Still's Disease with Liver Failure with No Response to Tocilizumab Therapy.
A 21-year-old woman with refractory systemic flare of adult-onset Still's disease with liver failure despite high-dose corticosteroids, cyclosporine, tacrolimus, and tocilizumab, was successfully treated with additional use of etanercept. Etanercept at a dose of 50 mg weekly was partially effective but could not reduce the dose of concomitant betamethasone from 5 mg/day. Etanercept at a dose of 75 mg weekly could lead her to clinical remission and enabled successful tapering off the corticosteroids and discontinuation of etanercept. Normalization of serum C-reactive protein and interleukin 6 and persistent elevation of serum tumor necrosis factor α under the treatment with high-dose corticosteroids and immunosuppressants suggest that tumor necrosis factor α was more deeply involved than at least interleukin 6 in the pathogenesis of refractoriness of the disease in this patient, and these findings might be indicative of potential efficacy for adjunctive use of a tumor necrosis factor inhibitor rather than an interleukin 6 inhibitor.
Division of Rheumatology, Nagoya City University Hospital and Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Taio
T
Naniwa
Division of Rheumatology, Nagoya City University Hospital and Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Shinya
S
Tamechika
Division of Rheumatology, Nagoya City University Hospital and Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Shiho
S
Iwagaitsu
Division of Rheumatology, Nagoya City University Hospital and Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Shinji
S
Maeda
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Hiroyuki
H
Togawa