title: Usefulness of tacrolimus for refractory adult-onset still's disease: Report of six cases.
abstract: Six patients with refractory adult-onset Still's disease (AOSD) were treated with tacrolimus (TAC). Patient 1 was pregnant, for whom high-dose corticosteroid (CS) monotherapy did not achieve clinical remission, whereas TAC concomitant with CS was successful, and her baby had no apparent abnormalities. Patient 2 had hemophagocytic syndrome (HPS), for whom high-dose CS monotherapy did not achieve clinical remission, whereas TAC improved HPS, and a complete clinical remission was achieved with concomitant administration of TAC and methotrexate (MTX) with CS. Cases 3-5 could not have reduced CS doses due to repeated recurrences and other disease-modifying antirheumatic drugs, including MTX, Cyclosporine A, and tumor necrosis factor alpha inhibitors, did not control disease activity. TAC administration allowed for reduced CS doses. Case 6 experienced adverse effects, and TAC was discontinued due to elevated serum creatinine and potassium levels. TAC was useful for five of six patients, which suggests it as an option for refractory AOSD.
authors.affiliation: a 3rd Department of Internal medicine , Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital , Obihiro , Hokkaido , Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: a 3rd Department of Internal medicine , Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital , Obihiro , Hokkaido , Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Odani
authors.affiliation: a 3rd Department of Internal medicine , Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital , Obihiro , Hokkaido , Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: a 3rd Department of Internal medicine , Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital , Obihiro , Hokkaido , Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takeda
authors.affiliation: a 3rd Department of Internal medicine , Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital , Obihiro , Hokkaido , Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kikuchi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D016572:Cyclosporine; D016559:Tacrolimus; D008727:Methotrexate
keywords: Adult-Onset Still's disease; Hemophagocytic syndrome; Pregnancy; Tacrolimus