Novartis Pharma AG, Basel, Switzerland.
Novartis Pharma AG, Basel, Switzerland.
Semin Arthritis Rheum. 2017 Oct;47(2):295-302. doi: 10.1016/j.semarthrit.2017.06.006. Epub 2017 Jun 23.
The literature contains many reports of the use of commercially available anti-IL-1 agents (anakinra/Kineret, canakinumab/Ilaris, or rilonacept/Arcalyst) in treatment-resistant adult-onset Still's disease (AOSD). These have been widely summarized in many review articles, but a full account of all reports with each of the agents used is not available. This literature review includes all reports of treatment outcomes in patients treated for AOSD with any commercially available anti-IL-1 agent (excluding cases of unconfirmed or atypical AOSD or treatments only for rare AOSD complications). The summary makes use of tabular formats, to identify the available reports and to provide data for compiling and comparison to classical therapies. For each anti-IL-1 agent used, a table shows the frequency of remission during treatment and the frequency of stopping or reducing steroid use, which were reported in almost all articles. A brief textual summary is used to describe other relevant but less often described efficacy aspects and any safety information. The compiled data show that treatment with all anti-IL-1 agents is effective in AOSD, indicating that IL-1 has a central role in the pathogenesis of AOSD. Rates of full or partial remission with each agent were similar to each other (91-100%) and superior to the outcomes published for classical therapies. Primary treatment failures were rare, but efficacy was lost over time in some cases. Of note, the newer anti-IL-1 agents with longer half-lives may show prolonged efficacy. An articular involvement seems to be less responsive than systemic features of disease. However, long-term follow-up shows that efficacy may persist for many years. There is substantial evidence that anti-IL-1 agents have a strong steroid-sparing effect and considerable evidence that the use of disease-modifying anti-rheumatic drugs can also be reduced or stopped. Thus, the use of anti-IL-1 agents may reduce the side-effects of co-treatment. The high response rate to anti-IL-1 agents, especially in refractory AOSD cases, suggests that their appropriate use in a timely manner can slow disease progression and reduce treatment side-effects.
文献中包含许多关于使用市售抗 IL-1 药物（阿那白滞素/凯那单抗、卡那单抗/依拉利司、或瑞那司特/阿卡利斯）治疗难治性成人斯蒂尔病（AOSD）的报告。这些已在许多综述文章中广泛总结，但尚未全面列出使用每种药物的所有报告。本文献综述包括使用任何市售抗 IL-1 药物治疗 AOSD 患者的所有报告（不包括未确诊或非典型 AOSD 病例或仅治疗罕见 AOSD 并发症的病例）。该综述采用表格格式，以确定可用报告，并为汇编数据和与传统疗法进行比较提供数据。对于使用的每种抗 IL-1 药物，表格显示治疗期间缓解的频率以及停止或减少使用激素的频率，这些报告几乎出现在所有文章中。简短的文本摘要用于描述其他相关但较少描述的疗效方面和任何安全性信息。汇编的数据表明，所有抗 IL-1 药物在 AOSD 中均有效，表明 IL-1 在 AOSD 的发病机制中具有核心作用。每种药物的完全或部分缓解率彼此相似（91-100%），优于经典疗法的疗效。原发治疗失败很少见，但在某些情况下疗效会随时间丧失。值得注意的是，半衰期较长的新型抗 IL-1 药物可能表现出持久的疗效。关节受累似乎不如疾病的全身特征敏感。然而，长期随访表明，疗效可能持续多年。有大量证据表明抗 IL-1 药物具有很强的类固醇节省作用，也有大量证据表明可以减少或停止使用疾病修饰抗风湿药物。因此，使用抗 IL-1 药物可能会减少联合治疗的副作用。抗 IL-1 药物的高反应率，特别是在难治性 AOSD 病例中，表明及时适当使用这些药物可以减缓疾病进展并减少治疗副作用。
