当前位置: X-MOL 学术Arthritis Res. Ther. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Management of adult-onset Still's disease with interleukin-1 inhibitors: evidence- and consensus-based statements by a panel of Italian experts.
Arthritis Research & Therapy ( IF 4.9 ) Pub Date : 2019-12-11 , DOI: 10.1186/s13075-019-2021-9
Serena Colafrancesco 1 , Maria Manara 2 , Alessandra Bortoluzzi 3 , Teodora Serban 4 , Gerolamo Bianchi 4 , Luca Cantarini 5 , Francesco Ciccia 6 , Lorenzo Dagna 7 , Marcello Govoni 3 , Carlomaurizio Montecucco 8 , Roberta Priori 1 , Angelo Ravelli 9 , Paolo Sfriso 10 , Luigi Sinigaglia 2 ,
Affiliation  

Adult-onset Still’s disease (AOSD) is a rare inflammatory condition characterized by fever, rash, and arthritis. Because of its rarity, clinical trials are inherently small and often uncontrolled. Our objective was to develop recommendations for the use of interleukin (IL)-1 inhibitors in the management of patients with AOSD, based on the best evidence and expert opinion. A panel of 10 experts (9 rheumatologists and 1 pediatrician) was established. The first step was dedicated to a comprehensive literature review and development of statements. Two separate literature searches were performed on the MEDLINE (Pubmed), EMBASE, and BIOSIS databases through April 2018 to identify (1) differences and similarities between AOSD and pediatric Still’s disease (systemic juvenile idiopathic arthritis [SJIA]) and (2) the efficacy and safety of IL-1 inhibitors in AOSD treatment. In the second step, the statements were submitted in a Delphi process to a panel of 67 rheumatologists. Consensus threshold was set at 66%: positive, > 66% of voters selected scores 3 to 5; negative, > 66% of voters selected scores 1 or 2. In the third step, the voting results were analyzed, and the statements were finalized. Eleven statements were developed. Forty-six of 67 rheumatologists (72%) participated in the Delphi process. A positive consensus was reached after the first round of voting and was full (> 95%) on the majority of statements. A large consensus was achieved in considering AOSD and SJIA as the same disease. The use of anti-IL-1 therapies in refractory patients was considered quite safe and effective both as the first and as a subsequent line of biologic treatment, especially in systemic patients. Because of the lack of head-to-head comparisons, a different profile of efficacy among IL-1 inhibitors could not be established. There was a large consensus that failure of the first IL-1 inhibitor does not preclude response to another one. The lack of studies comparing early versus late treatment did not allow to draw conclusions; however, data from SJIA suggest a better response in early treatment. The Delphi method was used to develop recommendations that we hope will help clinicians in the management of patients with AOSD refractory to conventional therapies.

中文翻译:

用白细胞介素-1抑制剂治疗成人发作的斯蒂尔氏病:意大利专家小组基于证据和共识的陈述。

成人发作的斯蒂尔氏病(AOSD)是一种罕见的炎症性疾病,其特征是发烧,皮疹和关节炎。由于其稀有性,因此临床试验本来就很小,而且常常不受控制。我们的目标是根据最佳证据和专家意见,为在AOSD患者治疗中使用白介素(IL)-1抑制剂制定建议。建立了一个由10名专家组成的小组(9名风湿病学家和1名儿科医生)。第一步致力于全面的文献综述和陈述的发展。在MEDLINE(公开),EMBASE,以及截至2018年4月的BIOSIS数据库,以确定(1)AOSD与小儿斯蒂尔氏病(系统性幼年特发性关节炎[SJIA])之间的异同,以及(2)IL-1抑制剂在AOSD治疗中的有效性和安全性。第二步,通过Delphi程序将陈述提交67位风湿病专家小组。共识阈值设置为66%:积极,超过66%的选民选择3到5分;否定,> 66%的选民选择得分为1或2。在第三步中,分析投票结果,并最终确定陈述。制定了11项声明。67名风湿病医生中有46名(72%)参加了德尔菲过程。在第一轮投票后达成了积极共识,并且对大多数声明都达成了充分共识(> 95%)。在将AOSD和SJIA视为同一疾病方面已达成了广泛共识。在难治性患者中使用抗IL-1疗法被认为是非常安全和有效的,无论是作为第一线还是后续的生物治疗方法,尤其是在全身性患者中。由于缺乏直接的比较,因此无法确定IL-1抑制剂之间的功效差异。人们普遍认为,第一种IL-1抑制剂的失败并不排除对另一种IL-1抑制剂的反应。缺乏比较早期和晚期治疗的研究无法得出结论。但是,SJIA的数据表明,早期治疗有更好的反应。Delphi方法用于提出建议,我们希望这些建议将有助于临床医生处理传统疗法难治的AOSD患者。
更新日期:2019-12-11
down
wechat
bug