ANAKINRA VERY EFFECTIVE FOR ADULT STILL'S DISEASE 

NEW YORK (Reuters Health) Dec 24 - The dramatic efficacy of the IL-1 receptor antagonist anakinra in adult-onset Still's diseases is maintained over the long term, according to researchers.

In a December 6th online paper in Arthritis Care & Research, Dr. Cecilia Giampietro of the Pierre et Marie Curie, School of Medicine, Paris and colleagues note that no randomized controlled clinical trials have been conducted, and treatment of this rare inflammatory disease, which can lead to chronic arthritis, remains mainly empirical.

Non-steroidal anti-inflammatory drugs are the classical first-line approach, but they may have a fleeting impact and potentially serious long-term side effects. The value of other agents such as methotrexate and TNF blockers is controversial.

However, reports of anakinra's rapid efficacy in patients refractory to other synthetic or biological treatments suggest that IL-1 plays a pivotal role in pathogenesis.

To gain further information on the drug's performance, the team conducted a French national survey and received information on 28 patients, with a mean age of 40.3 years and a mean disease duration at anakinra commencement of 9.3 years.

In all cases, patients had not responded to steroids and disease-modifying antirheumatic drugs. They did respond to anakinra, which allowed a rapid and sustained decrease in steroid doses. The agent was well-tolerated and adverse events were rated as mild.

At last follow-up after a mean of 23 months, 16 patients (57%) were still being treated with anakinra, including 12 who were in complete remission and four who had a partial response. Ten were on the standard dose; six were receiving a tapered dose.

Among patients who relapsed, the reintroduction of anakinra at the standard dose led to new remission, the authors reported.

Three patients stopped anakinra because of complete remission. Another four stopped when the drug became ineffective. Two stopped treatment because of an unsatisfactory response and one because of intended pregnancy.

The investigators say that while dose tapering or discontinuation was associated with relapse in half of patients, anakinra "was consistently efficacious... and displayed good therapeutic maintenance."

Overall, patients "experienced a dramatic response to anakinra, with no primary treatment failure," they wrote.

Dr. Giampietro did not respond to requests for comments.

SOURCE: http://bit.ly/UpFXcQ

Arthritis Care Res 2012.