Kokkinos Alexander, Iliopoulos Alexios, Greka Paraskevi, Efthymiou Anna, Katsilambros Nicholas, Sfikakis Petros P
First Propaedeutic Department of Internal Medicine, Laikon General Hospital, Athens University Medical School, 17 Ag. Thoma St, 11527 Athens, Greece.
Clin Rheumatol. 2004 Feb;23(1):45-9. doi: 10.1007/s10067-003-0775-5. Epub 2003 Nov 15.
In this prospective, non-comparative case series, four patients with severe and highly active adult-onset Still's disease (AOSD), refractory to high doses of corticosteroids (which had been combined with methotrexate in three of them) and methotrexate were treated with infliximab (initial dose 3-5 mg/kg, continuing at intervals depending on the patient's individual disease activity). Resolution of their symptoms, which was evident within few days after the first infusion, and a parallel rapid improvement of the acute inflammatory response indices were observed in all. Concomitant corticosteroid treatment was reduced after the first courses of treatment with infliximab, which was well tolerated, and complete disease remission was sustained during a 5-18-month follow-up period. Although further studies to confirm long-term efficacy and safety in larger numbers of patients are needed, we suggest that administration of infliximab with observation for objective improvement is the treatment of choice in cases of AOSD refractory to conventional treatment.
在这个前瞻性、非对照病例系列中，4例患有严重且高度活跃的成人斯蒂尔病（AOSD）的患者，对高剂量皮质类固醇（其中3例联合了甲氨蝶呤）及甲氨蝶呤治疗无效，接受了英夫利昔单抗治疗（初始剂量3 - 5mg/kg，根据患者个体疾病活动情况定期持续给药）。首次输注后数天内，所有患者症状均明显缓解，同时急性炎症反应指标迅速改善。英夫利昔单抗首个疗程治疗后，伴随的皮质类固醇治疗减少，且耐受性良好，在5 - 18个月的随访期内维持了疾病完全缓解。尽管需要进一步研究以证实英夫利昔单抗在更多患者中的长期疗效和安全性，但我们建议，对于传统治疗无效的AOSD病例，给予英夫利昔单抗并观察客观改善情况是首选治疗方法。
