AUTHOR=Vitale Antonio , Cavalli Giulio , Ruscitti Piero , Sota Jurgen , Colafrancesco Serena , Priori Roberta , Valesini Guido , Argolini Lorenza Maria , Baldissera Elena , Bartoloni Elena , Cammelli Daniele , Canestrari Giovanni , Cavallaro Elena , Massaro Maria Grazia , Cipriani Paola , De Marchi Ginevra , De Vita Salvatore , Emmi Giacomo , Frassi Micol , Gerli Roberto , Gremese Elisa , Iannone Florenzo , Fornaro Marco , Paladini Anna , Lopalco Giuseppe , Manna Raffaele , Mathieu Alessandro , Montecucco Carlomaurizio , Mosca Marta , Piazza Ilaria , Piga Matteo , Pontikaki Irene , Romano Micol , Rossi Silvia , Rossini Maurizio , Silvestri Elena , Stagnaro Chiara , Talarico Rosaria , Frediani Bruno , Tincani Angela , Viapiana Ombretta , Vitiello Gianfranco , Galozzi Paola , Sfriso Paolo , Gaggiano Carla , Grosso Salvatore , Rigante Donato , Dagna Lorenzo , Giacomelli Roberto , Cantarini Luca 

TITLE=Comparison of Early vs. Delayed Anakinra Treatment in Patients With Adult Onset Still's Disease and Effect on Clinical and Laboratory Outcomes

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00042

DOI=10.3389/fmed.2020.00042

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Aim of this study was to search for any difference in the outcome of patients with adult onset Still's disease (AOSD) treated with anakinra (ANK) in relation with the interval between disease onset and the start of anti-interleukin(IL)-1 treatment and according with the different lines of ANK treatment.</p><p><bold>Patients and Methods:</bold> One hundred and forty-one AOSD patients treated with ANK have been retrospectively assessed. Statistically significant differences (<italic>p</italic> &lt; 0.05) were analyzed in the frequency of ANK effectiveness, primary or secondary inefficacy to ANK and rate of resolution of clinical and laboratory AOSD manifestations after 3, 6, and 12 months since ANK treatment according with different lines of treatment and different times between AOSD onset and start of ANK.</p><p><bold>Results:</bold> No significant differences were identified in the ANK effectiveness and frequency of primary or secondary inefficacy for patients starting ANK within 6 months (<italic>p</italic> = 0.19, <italic>p</italic> = 0.14, and <italic>p</italic> = 0.81, respectively) or 12 months (<italic>p</italic> = 0.37, <italic>p</italic> = 0.23, and <italic>p</italic> = 0.81, respectively) since AOSD onset compared with patients starting ANK thereafter; no significant differences were identified in ANK effectiveness and primary or secondary inefficacy according with different lines of ANK treatment (<italic>p</italic> = 0.06, <italic>p</italic> = 0.19, and <italic>p</italic> = 0.13, respectively). Patients starting ANK within 6 and 12 months since AOSD onset showed a significantly quicker decrease of erythrocyte sedimentation rate and C-reactive protein than observed among patients undergoing ANK treatment after 6 and 12 months. The number of swollen joints at the 3 month follow-up visit was significantly lower among patients undergoing ANK within 6 months since AOSD onset (<italic>p</italic> = 0.01), while no significance was identified at the 6 and 12 month assessments (<italic>p</italic> = 0.23 and <italic>p</italic> = 0.45, respectively). At the 3 and 6 month visits, the number of swollen joints was significantly higher among patients previously treated with conventional and biological disease modifying anti-rheumatic drugs (DMARDs) compared with those formerly treated only with conventional DMARDs (<italic>p</italic> &lt; 0.017).</p><p><bold>Conclusions:</bold> Clinical and therapeutic outcomes are substantially independent of how early ANK treatment is started in AOSD patients. However, a faster ANK effectiveness in controlling systemic inflammation and resolving articular manifestations may be observed in patients benefiting from IL-1 inhibition as soon as after disease onset.</p>