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. - 22:12(2023). [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
Caso 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.
