We performed a comprehensive systematic targeted literature review and used the Delphi method to formulate expert consensus statements to guide the treatment of adult-onset Still's disease (AOSD) to achieve an early and long-term remission. Seven candidate statements were generated and reached consensus in the first round of voting by the panel of experts. We postulate: (i) In patients with AOSD with predominant arthritis at onset who achieved no disease control with glucocorticoids (GCs), the use of methotrexate can be considered, whereas the use of cyclosporin A and low-dose GCs should not (Statements 1–3); (ii) In patients with AOSD with poor prognostic factors at diagnosis, an IL-1 inhibitor (IL-1i) in addition to GCs should be taken into consideration as early as possible (Statement 4); (iii) A switch to an IL-6 inhibitor (IL-6i) may be considered in patients with AOSD with prevalent joint involvement, who are unresponsive or intolerant to IL-1i (Statement 5); (iv) Drug tapering or discontinuation may be considered in patients who achieved a sustained clinical and laboratory remission with IL-1i (Statement 6); (v) In patients with AOSD who failed to attain a good clinical response with an IL-1i, switching to an IL-6i may be considered in alternative to a different IL-1i. TNF-inhibitors may be considered as a further choice in patients with a prominent joint involvement (Statement 7). These statements will help clinicians in treatment decision making in patients with AOSD.
Expert consensus on the treatment of patients with adult-onset still's disease with the goal of achieving an early and long-term remission / Giacomelli R.; Caporali R.; Ciccia F.; Colafrancesco S.; Dagna L.; Govoni M.; Iannone F.; Leccese P.; Montecucco C.; Pappagallo G.; Pistone G.; Priori R.; Ruscitti P.; Sfriso P.; Cantarini L.; Belfiore N.; Bernardi C.; Gabini M.; Bettio S.; Brucato A.; Italiano G.; Cantatore F.P.; Iacono D.; Pantano I.; Tirri E.; Ursini F.; Monaco A.L.; Caso F.; Quartuccio L.; Chimenti M.S.; Gattamelata A.; Gremese E.; Paroli M.; Picchianti-Diamanti A.; Sebastiani G.D.; Favalli E.; Sulli A.; Frassi M.; Faggioli P.; Foti R.; Campochiaro C.; Cavalli G.; Tomelleri A.; Manara M.; De Stefano L.; De Angelis R.; Parisi S.; Lopalco G.; Piga M.; Marotto D.; Colaci M.; Padula A.; Guggino G.; Emmi G.; Baldini C.; Sota J.; Vitale A.; Berti A.; Bartoloni E.; Grava C.; Bindoli S.; Vitetta R.. - In: AUTOIMMUNITY REVIEWS. - ISSN 1568-9972. - ELETTRONICO. - 22:12(2023), pp. 103400.1-103400.10. [10.1016/j.autrev.2023.103400]
Expert consensus on the treatment of patients with adult-onset still's disease with the goal of achieving an early and long-term remission
Ursini F.;
2023
Abstract
We performed a comprehensive systematic targeted literature review and used the Delphi method to formulate expert consensus statements to guide the treatment of adult-onset Still's disease (AOSD) to achieve an early and long-term remission. Seven candidate statements were generated and reached consensus in the first round of voting by the panel of experts. We postulate: (i) In patients with AOSD with predominant arthritis at onset who achieved no disease control with glucocorticoids (GCs), the use of methotrexate can be considered, whereas the use of cyclosporin A and low-dose GCs should not (Statements 1–3); (ii) In patients with AOSD with poor prognostic factors at diagnosis, an IL-1 inhibitor (IL-1i) in addition to GCs should be taken into consideration as early as possible (Statement 4); (iii) A switch to an IL-6 inhibitor (IL-6i) may be considered in patients with AOSD with prevalent joint involvement, who are unresponsive or intolerant to IL-1i (Statement 5); (iv) Drug tapering or discontinuation may be considered in patients who achieved a sustained clinical and laboratory remission with IL-1i (Statement 6); (v) In patients with AOSD who failed to attain a good clinical response with an IL-1i, switching to an IL-6i may be considered in alternative to a different IL-1i. TNF-inhibitors may be considered as a further choice in patients with a prominent joint involvement (Statement 7). These statements will help clinicians in treatment decision making in patients with AOSD.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
