Adult-onset Still’s disease outcomes better with frontline biological vs csDMARD therapy

In the first-line treatment of patients with adult-onset Still’s disease (AOSD), biological disease-modifying antirheumatic drug (DMARD) therapy is associated with increased likelihood of achieving sustained, event-free remission in addition to fewer complications compared with conventional synthetic (cs) DMARDs, according to a study from Germany.

The study included 86 patients with AOSD (mean age 39.4 years, 58 percent female, 42 percent White), who had an incident diagnosis or a flare without any maintenance treatment, including glucocorticoids. These patients met the Yamaguchi classification criteria and had active disease without current treatment. All patients had documented follow-up evaluations at weeks 12 and 72.

The primary endpoint was sustained, event-free remission. Sustained remission was defined as C-reactive protein levels <10 mg/L and the absence of fever, arthritis, and AOSD-associated rash beginning at week 12 and maintained throughout week 72. Meanwhile, an event-free state was defined as the absence of any complications from weeks 12 through 72.

Of the patients, 51 percent had received a first-line biological DMARD and 49 percent received a first-line csDMARD. Compared with csDMARD, biological DMARD therapy was associated with sevenfold greater odds of achieving sustained, event-free remission (odds ratio [OR], 7.20, 95 percent confidence interval [CI], 2.50–36.64; p=0.0007). At week 72, the percentage of patients with sustained, event-free remission was 50 percent in the biological DMARD group and 12 percent in the csDMARD group.

Glucocorticoid-related complications, including new-onset arterial hypertension and related skin diseases, occurred in five patients in the csDMARD group and none in the biological DMARD group. Three patients in the csDMARD group and none in the biological DMARD group died.