Kedor Claudia, Tomaras Stylianos, Baeumer Daniel, Feist Eugen
Corporate Member, Department of Rheumatology and Clinical Immunology and Berlin Institute of Health, Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, 10117 Berlin, Germany.
Department of Rheumatology, Helios Clinic Vogelsang-Gommern, Gommern, Germany.
Ther Adv Musculoskelet Dis. 2021 Nov 24;13:1759720X211059598. doi: 10.1177/1759720X211059598. eCollection 2021.
The past decade has seen increasingly rapid advances in understanding the pathogenic nature of adult-onset Still's disease (AOSD) and its shared symptoms with the systemic juvenile idiopathic arthritis (sJIA). Interleukin-1 (IL-1) blocking agents are key elements in the treatment. In this updated systematic review, we focus on studies on efficacy and safety of IL-1 blockers published in the past 5 years and review on latest available therapies.
We conducted searches using Medline, Biosis, Embase, and Cochrane databases between 2016 and 2021 using the terms AOSD, IL1, IL-18, canakinumab, anakinra, tadekinig, and rilonacept and if applicable their trade names. Duplicates, case reports, and manuscripts with incomplete data were excluded.
Of the 1013 screened publications, 17 were eligible after careful selection. We only found two published randomized controlled studies in the past 5 years. Review manuscripts of rare diseases, like our work, usually rely on retrospective studies and case series. Anakinra and canakinumab can be successfully used as first- or further-line treatment in patients with AOSD refractory to steroids. A homogeneous outcome is not established yet. Thus, a combination of clinical and laboratory tests can support the experienced clinician in the decision-making process.
The approval of IL-1 inhibitors for AOSD brought us into a new era in the treatment of AOSD. The overall efficacy-safety profile of the IL-1 inhibitors is favorable reflecting a targeted approach as standard of care. We can expect that the successful treatment of AOSD with IL-1 inhibition will facilitate further clinical and basic research with impact on other auto-inflammatory and hyper-inflammatory conditions.
在过去十年中，人们对成人斯蒂尔病（AOSD）的致病本质及其与系统性幼年特发性关节炎（sJIA）的共同症状的理解取得了越来越迅速的进展。白细胞介素-1（IL-1）阻断剂是治疗的关键要素。在本次更新的系统评价中，我们重点关注过去5年发表的关于IL-1阻断剂疗效和安全性的研究，并对最新可用疗法进行综述。
我们在2016年至2021年间使用“成人斯蒂尔病”“IL-1”“IL-18”“卡那单抗”“阿那白滞素”“他德金单抗”和“利罗那肽”等术语，并在适用时使用它们的商品名，在Medline、Biosis、Embase和Cochrane数据库中进行检索。排除重复项、病例报告和数据不完整的手稿。
在筛选的1013篇出版物中，经过仔细筛选后有17篇符合条件。我们在过去5年中仅发现两项已发表的随机对照研究。像我们的研究这样的罕见病综述手稿通常依赖回顾性研究和病例系列。阿那白滞素和卡那单抗可成功用作对类固醇难治的AOSD患者的一线或二线治疗。尚未确立统一的结果。因此，临床和实验室检查的结合可以在决策过程中为经验丰富的临床医生提供支持。
IL-1抑制剂被批准用于AOSD使我们进入了AOSD治疗的新时代。IL-1抑制剂的总体疗效-安全性概况良好，反映了作为护理标准的靶向治疗方法。我们可以预期，用IL-1抑制成功治疗AOSD将促进对其他自身炎症性和高炎症性疾病有影响的进一步临床和基础研究。
