Ruscitti Piero, Cipriani Paola, Liakouli Vasiliki, Guggino Giuliana, Carubbi Francesco, Berardicurti Onorina, Ciccia Francesco, Giacomelli Roberto
Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila.
Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania "Luigi Vanvitelli," Naples, Italy.
Medicine (Baltimore). 2019 Apr;98(15):e15123. doi: 10.1097/MD.0000000000015123.
To assess the effectiveness of the treatment with high dosage of corticosteroids (CCSs), as first-line therapy, in inducing remission in naïve Adult-onset Still's disease (AOSD) patients compared with low dosage of CCSs, after 6 months. To further evaluate the rate of patients maintaining the remission and the rate of CCSs discontinuation, after additional 12 months of follow-up.A retrospective evaluation of patients prospectively followed was designed to compare the rate of clinical remission in naïve AOSD patients treated with high dosages of CCSs (0.8-1 mg/kg/day of prednisone-equivalent) or low dosage of CCSs (0.2-0.3 mg/kg/day of prednisone-equivalent), after 6 months. An additional analysis was performed to compare the rate of monocyclic pattern between these groups, after further 12 months of follow-up.The clinical remission was achieved in a higher percentage of patients treated with the first-line treatment with high dosage of CCSs than treated the first-line treatment with low dosage of CCSs. At the end of 18 months of follow-up, a larger percentage of patients treated the first-line treatment with high dosage of CCSs was classified as monocyclic pattern and discontinued CCSs when compared with patients treated the first-line treatment with low dosage of CCSs. Patients defined as CCSs non-responder were treated with methotrexate (MTX)+CCSs or with combination therapy CCSs+MTX+biologic drug. The clinical remission was observed in a percentage of these patients.We showed the effectiveness of the first-line treatment with high dosage of CCSs in inducing clinical remission in naïve AOSD patients when compared with the first-line treatment with low dosage of CCSs. The first-line treatment with high dosage of CCSs was also associated with the achievement of monocyclic pattern and CCSs discontinuation, after 18 months of follow-up.
评估高剂量皮质类固醇（CCSs）作为一线治疗，在初治成人斯蒂尔病（AOSD）患者中诱导缓解的有效性，并与低剂量CCSs进行比较，随访6个月。在额外随访12个月后，进一步评估患者维持缓解的比例和停用CCSs的比例。对前瞻性随访的患者进行回顾性评估，以比较初治AOSD患者接受高剂量CCSs（相当于泼尼松0.8 - 1毫克/千克/天）或低剂量CCSs（相当于泼尼松0.2 - 0.3毫克/千克/天）治疗6个月后的临床缓解率。在进一步随访12个月后，对这些组之间的单循环模式比例进行额外分析。接受高剂量CCSs一线治疗的患者实现临床缓解的比例高于接受低剂量CCSs一线治疗的患者。在随访18个月结束时，与接受低剂量CCSs一线治疗的患者相比，接受高剂量CCSs一线治疗的患者中有更大比例被归类为单循环模式并停用CCSs。被定义为CCSs无反应者的患者接受甲氨蝶呤（MTX）+CCSs或联合治疗CCSs+MTX+生物药物治疗。在这些患者中有一定比例观察到临床缓解。我们表明，与低剂量CCSs一线治疗相比，高剂量CCSs一线治疗在初治AOSD患者中诱导临床缓解有效。在随访18个月后，高剂量CCSs一线治疗还与实现单循环模式和停用CCSs相关。
