Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Service de Rhumatologie, Place Amélie Raba Léon, 33076, Bordeaux, France.
Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Service de Médecine Interne, Avenue Magellan, 33600, Pessac, France.
Arthritis Res Ther. 2019 Feb 12;21(1):53. doi: 10.1186/s13075-019-1838-6.
Adult-onset Still's disease (AOSD) phenotype appears to be dichotomized in systemic or chronic articular forms. As biologicals and particularly interleukin (IL)-1 and IL-6 blockers play a more and more prominent role in the treatment, their place requires clarification. This study aimed to identify factors predictive of treatment response to anakinra or tocilizumab and investigate whether the choice of biotherapy and delays in the initiation of biotherapy influenced the likelihood of steroid discontinuation.
A multicenter exploratory retrospective study included all patients diagnosed with AOSD and receiving biological treatments in three regional hospitals until 2018. Clinical and biological characteristics at diagnosis and treatment-related data were collected. The nonparametric Mann-Whitney test was used to perform univariate analysis for quantitative variables, and Fisher's exact test was used for qualitative variables.
Twenty-seven patients were included. All but one patient achieved remission with either anakinra or tocilizumab. Treatment responses depended on disease phenotype: the presence of arthritis and a chronic articular phenotype were associated with a substantial response to tocilizumab with p = 0.0009 (OR 36 [2.6-1703]) and p = 0.017 (OR 10 [1.22-92.6]), respectively, whereas the systemic form and the absence of arthritis were associated with a substantial response to anakinra with p = 0.0009 (OR 36 [2.6-1703]) and p = 0.017 (OR 10 [1.22-92.6]), respectively. Tocilizumab increased the likelihood of corticosteroid withdrawal (p = 0.029) regardless of delays in initiation or when it was initiated relative to other treatment in the overall therapeutic strategy.
This study highlights the therapeutic implications of the phenotypic dichotomy of AOSD and should help us better codify AOSD treatment.
成人Still 病（AOSD）的表型似乎分为全身性或慢性关节型。由于生物制剂，尤其是白细胞介素（IL）-1 和 IL-6 阻滞剂在治疗中发挥着越来越重要的作用，因此需要明确它们的地位。本研究旨在确定预测对阿那白滞素或托珠单抗治疗反应的因素，并探讨生物治疗的选择和生物治疗开始时间的延迟是否影响激素停药的可能性。
一项多中心探索性回顾性研究纳入了 2018 年前在三家区域医院接受生物治疗的所有 AOSD 患者。收集诊断时的临床和生物学特征以及治疗相关数据。采用非参数 Mann-Whitney 检验进行定量变量的单变量分析，采用 Fisher 确切检验进行定性变量的单变量分析。
共纳入 27 例患者。所有患者（除 1 例外）均接受阿那白滞素或托珠单抗治疗后缓解。治疗反应取决于疾病表型：关节炎的存在和慢性关节表型与托珠单抗的显著反应相关，p=0.0009（OR 36 [2.6-1703]）和 p=0.017（OR 10 [1.22-92.6]），而全身性表型和无关节炎与阿那白滞素的显著反应相关，p=0.0009（OR 36 [2.6-1703]）和 p=0.017（OR 10 [1.22-92.6]）。托珠单抗增加了皮质类固醇停药的可能性（p=0.029），无论其开始时间延迟与否，以及在整个治疗策略中相对于其他治疗开始时，都是如此。
本研究强调了 AOSD 表型二分法的治疗意义，应该有助于我们更好地制定 AOSD 治疗方案。
