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Pharmacologic Efficacy in Still's Disease

Jack Cush, MD

A systematic review of the effectiveness and safety of pharmacological treatments for adult-onset Still’s disease (AOSD) supports the use of either IL-1 or IL-6 inhibitors.

A metanalysis was performed using databases, trial registries, conference abstracts and published papers between 2012 and 2023, to assess outcomes discontinuation of treatments, complications, and treatment-related adverse events. 

A total of 44 studies assessed the value of NSAIDs corticosteroids (CS), conventional synthetic DMARDS, biologic DMARDs [including tocilizumab (TCZ), anakinra (ANK), and canakinumab (CNK)]. 

Three randomized controlled trials did not show statistically significant benefits of bDMARDs, but metaanalyses showed high remission and CS discontinuation rates. Specifically for each drug:

Remission 80% 73% 77%
Steroid D/C 57% 47% 34%





These data supports the use of either TCZ, ANK, and CNK therapy for AOSD. Yet the magnitude of effect and comparative effectiveness of treatments is uncertain.


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