6533b837fe1ef96bd12a3330

RESEARCH PRODUCT

Managing Adult-onset Still's disease: The effectiveness of high-dosage of corticosteroids as first-line treatment in inducing the clinical remission. Results from an observational study

Vasiliki LiakouliPaola CiprianiRoberto GiacomelliFrancesco CicciaOnorina BerardicurtiPiero RuscittiFrancesco CarubbiGiuliana Guggino

subject

Adult-OnsetMalePediatricsAdult-onset Still's diseaseDiseaseAdrenal Cortex Hormonecorticosteroids0302 clinical medicinemonocyclic patternAdrenal Cortex HormonesRetrospective StudieMedicine030212 general & internal medicineProspective StudiesProspective cohort studyRemission InductionDisease ManagementGeneral MedicineMiddle AgedTreatment OutcomeHigh dosage030220 oncology & carcinogenesisFemaleDrugStill's Disease Adult-OnsetResearch ArticleHumanAdultcorticosteroidmedicine.medical_specialtyLow dosageObservational StudyAdult-onset Still's diseaseFollow-Up StudieDose-Response Relationship03 medical and health sciencesremissionAdult-onset Still's disease; corticosteroids; first-line therapy; monocyclic pattern; remission; Adrenal Cortex Hormones; Adult; Disease Management; Dose-Response Relationship Drug; Female; Follow-Up Studies; Humans; Male; Methotrexate; Middle Aged; Prospective Studies; Remission Induction; Retrospective Studies; Still's Disease Adult-Onset; Treatment Outcomefirst-line therapyHumansRetrospective StudiesDose-Response Relationship Drugbusiness.industry6900Retrospective cohort studyStill's DiseaseFirst line treatmentSettore MED/16 - ReumatologiaProspective StudieMethotrexateObservational studybusinessFollow-Up Studies

description

Abstract To assess the effectiveness of the treatment with high dosage of corticosteroids (CCSs), as first-line therapy, in inducing remission in naïve Adult-onset Still's disease (AOSD) patients compared with low dosage of CCSs, after 6 months. To further evaluate the rate of patients maintaining the remission and the rate of CCSs discontinuation, after additional 12 months of follow-up. A retrospective evaluation of patients prospectively followed was designed to compare the rate of clinical remission in naïve AOSD patients treated with high dosages of CCSs (0.8–1 mg/kg/day of prednisone-equivalent) or low dosage of CCSs (0.2–0.3 mg/kg/day of prednisone-equivalent), after 6 months. An additional analysis was performed to compare the rate of monocyclic pattern between these groups, after further 12 months of follow-up. The clinical remission was achieved in a higher percentage of patients treated with the first-line treatment with high dosage of CCSs than treated the first-line treatment with low dosage of CCSs. At the end of 18 months of follow-up, a larger percentage of patients treated the first-line treatment with high dosage of CCSs was classified as monocyclic pattern and discontinued CCSs when compared with patients treated the first-line treatment with low dosage of CCSs. Patients defined as CCSs non-responder were treated with methotrexate (MTX)+CCSs or with combination therapy CCSs+MTX+biologic drug. The clinical remission was observed in a percentage of these patients. We showed the effectiveness of the first-line treatment with high dosage of CCSs in inducing clinical remission in naïve AOSD patients when compared with the first-line treatment with low dosage of CCSs. The first-line treatment with high dosage of CCSs was also associated with the achievement of monocyclic pattern and CCSs discontinuation, after 18 months of follow-up.

yearjournalcountryeditionlanguage
2019-01-01
10.1097/md.0000000000015123http://hdl.handle.net/11591/412968