title: Interleukin 1 inhibition with anakinra in adult-onset Still disease: a meta-analysis of its efficacy and safety.
abstract: BACKGROUND
  Anakinra is the first interleukin-1 inhibitor to be used in clinical practice, and recent evidence showed that interleukin-1 plays a pivotal role in the pathogenesis of adult-onset Still disease (AoSD). However, data concerning efficacy with anakinra use in different clinical trials has not been evaluated, and the overall remission of AoSD with anakinra treatment has not been well defined.
  
  
  METHODS
  We conducted a search on Embase, PubMed, and the Cochrane Library for relevant trials. Statistical analyses were conducted to calculate the overall remission rates, odds ratios (OR), and 95% confidence intervals (CI), by using either random effects or fixed effect models according to the heterogeneity.
  
  
  RESULTS
  Of the 273 articles that were identified, 265 were excluded. Eight studies were eligible for inclusion. The overall remission rate and complete remission rate of anakinra in AoSD patients were 81.66% (95% CI: 69.51%-89.69%) and 66.75% (95% CI: 59.94%-75.3%), respectively. Compared with the controls, the use of anakinra was associated with a significant remission in AoSD, with an OR of 0.16 (95% CI: 0.06-0.44, P=0.0005). There were also significant reductions of the dosage of corticosteroid (mean difference =21.19) (95% CI: 13.2-29.18, P<0.0001) from anakinra onset to the latest follow up time. Clinical and laboratory parameters were all improved, and anakinra was well tolerated in patients with AoSD. No evidence of publication bias was observed.
  
  
  CONCLUSIONS
  Our study has shown that anakinra is effective in remitting the manifestations of AoSD, with reduction of the dose of corticosteroid in patients with AoSD. Further, anakinra therapy was not associated with increased risk of adverse events, and it was well tolerated in patients with AoSD. Further research is still recommended to investigate these findings.
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Hong
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Zhihai
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Shuyin
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Xingguang
authors.initials: X
authors.lastname: Liang
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Kuifen
authors.initials: K
authors.lastname: Ma
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, People's Republic of China ; College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.
authors.forename: Xingguo
authors.initials: X
authors.lastname: Zhang
mesh_terms: D006801:Humans; D064420:Drug-Related Side Effects and Adverse Reactions; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D007375:Interleukin-1 / Q000037:antagonists & inhibitors; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy
chemical_list: D053590:Interleukin 1 Receptor Antagonist Protein; D007375:Interleukin-1
keywords: AoSD; adverse events; anakinra; clinical and laboratory parameters; efficacy; interleukin-1 inhibitor