TOPLINE:
Tocilizumab administration results in high remission rates in adult-onset Still’s disease (AOSD), but the recurrence rate increases on tocilizumab discontinuation, with a longer tocilizumab interval and lower prednisolone dose being critical for successful tocilizumab withdrawal.
METHODOLOGY:
- Tocilizumab is effective in reducing systemic inflammation and lowering glucocorticoid doses in patients with AOSD; however, the possibility of tocilizumab withdrawal has not been explored.
- This retrospective study assessed whether tocilizumab can be discontinued after achieving remission in 48 patients with AOSD.
- The systemic feature score, Pouchot score, and modified Pouchot score were used to evaluate the disease activity.
- Remission was characterized by the absence of symptoms related to Still’s disease, normal levels of erythrocyte sedimentation rate and C-reactive protein, and absence of treatment intensification requirement.
- Recurrence after tocilizumab discontinuation was defined as a disease flare with AOSD treatment intensification that necessitated either a ≥ 1.5-fold increase in glucocorticoid dosage and/or the initiation of a biologic agent.
TAKEAWAY:
- Over a median observation period of 5.1 years, 38 (79.2%) patients achieved remission at 6 months, of which 13 discontinued tocilizumab and the remaining 25 continued it.
- Among patients who discontinued tocilizumab on achieving remission, recurrence was noted in 50% within a year, typically after a mean period of 5.5 months after discontinuation.
- Patients in remission with longer tocilizumab intervals (> 14 days; P < .0002) or lower prednisolone doses (< 7 mg/d; P = .001) at the time of tocilizumab discontinuation showed better recurrence-free rates than those without.
- The duration of tocilizumab use, systemic feature score, and serum ferritin levels at tocilizumab discontinuation were not significantly different between patients who experienced recurrence and those who did not.
IN PRACTICE:
“Stable conditions with extended intervals of tocilizumab administration and very low doses of concomitant glucocorticoids are essential for successful discontinuation,” the authors wrote.
SOURCE:
The study was led by Hiroya Tamai, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, and published online in Rheumatology (Oxford).
LIMITATIONS:
The study was limited by its retrospective study design and a small sample size. Moreover, there could have been a selection bias as the attending physicians could use their discretion to initiate or stop tocilizumab treatment. The absence of a universally agreed-upon definition for remission or recurrence in AOSD made comparing the findings of this study with those of others challenging.
DISCLOSURES:
This study did not receive any specific funding from any bodies in public, commercial, or nonprofit sectors. Some of the authors reported receiving honoraria and research support from various pharmaceutical companies.
A version of this article appeared on Medscape.com.