: 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.

Giacomelli, R., Caporali, R., Ciccia, F., Colafrancesco, S., Dagna, L., Govoni, M., et al. (2023). Expert consensus on the treatment of patients with adult-onset still's disease with the goal of achieving an early and long-term remission. AUTOIMMUNITY REVIEWS, 1-10 [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

Chimenti, Maria Sole
2023-07-22

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.
22-lug-2023
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/16
English
Adult-onset Still's disease
Delphi method
Expert opinion statements
Treatment algorithm
Giacomelli, R., Caporali, R., Ciccia, F., Colafrancesco, S., Dagna, L., Govoni, M., et al. (2023). Expert consensus on the treatment of patients with adult-onset still's disease with the goal of achieving an early and long-term remission. AUTOIMMUNITY REVIEWS, 1-10 [10.1016/j.autrev.2023.103400].
Giacomelli, R; Caporali, R; Ciccia, F; Colafrancesco, S; Dagna, L; Govoni, M; Iannone, F; Leccese, P; Montecucco, C; Pappagallo, G; Pistone, G; Priori...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/351684
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