title: Efficacy of Low-Dose Tocilizumab on Relapsing Adult-Onset Still's Disease.
abstract: Still's disease is an inflammatory disorder of unknown etiology. First-line therapy is based on corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) but the frequency of relapses and corticosteroid-induced adverse events are limiting factors. The efficacy of intravenous tocilizumab (TCZ) has been shown at a dose of 8 mg/kg but the corticosteroid-sparing effect of intravenous low-dose TCZ followed by subcutaneous (SC) injection in the course of the disease has been poorly investigated. We report the case of a 28-year old Caucasian woman presenting a relapse of Still's disease eleven months after diagnosis under treatment with 6 mg of methylprednisolone. TCZ at a dose of 4 mg/kg every 2 weeks was combined with 32 mg of methylprednisolone, followed by 162 mg SC every 3 weeks. Evolution was rapidly favourable with a decrease in corticosteroid doses. We reviewed previously published cases.
authors.affiliation: Department of General Internal Medicine, Centres Hospitaliers Jolimont, Nivelles, Belgium. Xavier.Vandemergel@jolimont.be.
authors.forename: Xavier
authors.initials: X
authors.lastname: Vandemergel
authors.affiliation: CUB Hôpital Erasme, Nivelles, Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vandergheynst
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D012008:Recurrence; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; C502936:tocilizumab; D008775:Methylprednisolone
keywords: Relapse; Still’s disease; Tocilizumab