Frontiers in Medicine (Feb 2020)

Comparison of Early vs. Delayed Anakinra Treatment in Patients With Adult Onset Still's Disease and Effect on Clinical and Laboratory Outcomes

  • Antonio Vitale,
  • Giulio Cavalli,
  • Giulio Cavalli,
  • Piero Ruscitti,
  • Jurgen Sota,
  • Serena Colafrancesco,
  • Roberta Priori,
  • Guido Valesini,
  • Lorenza Maria Argolini,
  • Elena Baldissera,
  • Elena Bartoloni,
  • Daniele Cammelli,
  • Giovanni Canestrari,
  • Elena Cavallaro,
  • Maria Grazia Massaro,
  • Paola Cipriani,
  • Ginevra De Marchi,
  • Salvatore De Vita,
  • Giacomo Emmi,
  • Micol Frassi,
  • Roberto Gerli,
  • Elisa Gremese,
  • Florenzo Iannone,
  • Marco Fornaro,
  • Anna Paladini,
  • Giuseppe Lopalco,
  • Raffaele Manna,
  • Alessandro Mathieu,
  • Carlomaurizio Montecucco,
  • Marta Mosca,
  • Ilaria Piazza,
  • Matteo Piga,
  • Irene Pontikaki,
  • Micol Romano,
  • Silvia Rossi,
  • Maurizio Rossini,
  • Elena Silvestri,
  • Chiara Stagnaro,
  • Rosaria Talarico,
  • Bruno Frediani,
  • Angela Tincani,
  • Ombretta Viapiana,
  • Gianfranco Vitiello,
  • Paola Galozzi,
  • Paolo Sfriso,
  • Carla Gaggiano,
  • Salvatore Grosso,
  • Donato Rigante,
  • Lorenzo Dagna,
  • Lorenzo Dagna,
  • Roberto Giacomelli,
  • Luca Cantarini

DOI
https://doi.org/10.3389/fmed.2020.00042
Journal volume & issue
Vol. 7

Abstract

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Background: Aim of this study was to search for any difference in the outcome of patients with adult onset Still's disease (AOSD) treated with anakinra (ANK) in relation with the interval between disease onset and the start of anti-interleukin(IL)-1 treatment and according with the different lines of ANK treatment.Patients and Methods: One hundred and forty-one AOSD patients treated with ANK have been retrospectively assessed. Statistically significant differences (p < 0.05) were analyzed in the frequency of ANK effectiveness, primary or secondary inefficacy to ANK and rate of resolution of clinical and laboratory AOSD manifestations after 3, 6, and 12 months since ANK treatment according with different lines of treatment and different times between AOSD onset and start of ANK.Results: No significant differences were identified in the ANK effectiveness and frequency of primary or secondary inefficacy for patients starting ANK within 6 months (p = 0.19, p = 0.14, and p = 0.81, respectively) or 12 months (p = 0.37, p = 0.23, and p = 0.81, respectively) since AOSD onset compared with patients starting ANK thereafter; no significant differences were identified in ANK effectiveness and primary or secondary inefficacy according with different lines of ANK treatment (p = 0.06, p = 0.19, and p = 0.13, respectively). Patients starting ANK within 6 and 12 months since AOSD onset showed a significantly quicker decrease of erythrocyte sedimentation rate and C-reactive protein than observed among patients undergoing ANK treatment after 6 and 12 months. The number of swollen joints at the 3 month follow-up visit was significantly lower among patients undergoing ANK within 6 months since AOSD onset (p = 0.01), while no significance was identified at the 6 and 12 month assessments (p = 0.23 and p = 0.45, respectively). At the 3 and 6 month visits, the number of swollen joints was significantly higher among patients previously treated with conventional and biological disease modifying anti-rheumatic drugs (DMARDs) compared with those formerly treated only with conventional DMARDs (p < 0.017).Conclusions: Clinical and therapeutic outcomes are substantially independent of how early ANK treatment is started in AOSD patients. However, a faster ANK effectiveness in controlling systemic inflammation and resolving articular manifestations may be observed in patients benefiting from IL-1 inhibition as soon as after disease onset.

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