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Prescribing motivations and patients’ characteristics related to the use of biologic drugs in adult-onset Still’s disease: analysis of a multicentre “real-life” cohort

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Abstract

A growing body of evidence suggests the usability of biologic disease-modifying anti-rheumatic drugs (bDMARDs) in treating adult-onset Still’s disease (AOSD). In a multicentre “real-life” cohort, the physicians’ prescribing motivations and patients’ predictive characteristics of being treated with bDMARDs were assessed. Patients with AOSD, who were included in GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) cohort and treated with bDMARDs, were retrospectively assessed. Relevant data were collected by a review of clinical charts. Forty-four patients treated with bDMARDs were analysed, with slight male preponderance (52.3%) and a mean age of 39.3 ± 15.2 years. All patients were treated with corticosteroids (CCSs) (38.6% with low dosage) and 93.2% were treated with synthetic DMARDs (sDMARDs). Regarding the effectiveness of the first-line bDMARD, 65.6% of patients experienced a complete remission, defined as complete disappearance of both systemic and joint symptoms and normalisation of laboratory evidence of disease. The physicians’ prescribing motivations for bDMARDs were inadequate response to CCSs and/or sDMARDs, CCS-sparing effect and occurrence of macrophage activation syndrome (MAS). Analysing patients’ characteristics, chronic disease course (OR 3.09; 95%CI 1.22–7.80, p = 0.017), defined as disease with persistent symptoms, was predictive of being treated with bDMARDs, whereas age (OR 0.97, 95%CI 0.93–0.99, p = 0.048) was negatively associated, suggesting younger age as a further predictive factor. Patients with AOSD were treated with bDMARDs for inadequate response to CCSs and/or sDMARDs, CCS-sparing effect and MAS occurrence. Younger age and chronic disease course were patients’ predictive characteristics of being treated with bDMARDs.

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Acknowledgements

The authors thank Mrs. Federica Sensini for her technical assistance.

Funding

No specific funding was received for this work.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Delta 6 Building, PO box 67100, L’Aquila, Italy

    Piero Ruscitti, Paola Cipriani, Vasiliki Liakouli & Roberto Giacomelli

  2. Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Daniela Iacono, Ilenia Pantano & Francesco Ciccia

  3. Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy

    Francesco Caso & Raffaele Scarpa

  4. Rheumatologic and Systemic Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Medical School, Bari, Italy

    Federico Perosa

  5. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Fabiola Atzeni

  6. Rheumatology Unit, Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy

    Francesco Paolo Cantatore

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  1. Piero Ruscitti
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Contributions

All authors made substantial contributions to the conception or design of the work, the acquisition and interpretation of data. All authors contributed to the critical review and revision of the manuscript and approved the final version. All the authors agreed to be accountable for all aspects of the work.

PR: study design, data acquisition, statistical analysis, interpretation of data, writing of the first draft of the paper, review and acceptance; PC: study design, data acquisition, interpretation of data, review and acceptance; VL: study design, data acquisition, statistical analysis, interpretation of data, writing of the first draft of the paper, review and acceptance; DI: study design, data acquisition, interpretation of data, review and acceptance; IP: study design, data acquisition, interpretation of data, review and acceptance; FC: study design, data acquisition, interpretation of data, review and acceptance; FP: study design, data acquisition, interpretation of data, review and acceptance; FA: study design, data acquisition, interpretation of data, review and acceptance; FPC: study design, data acquisition, interpretation of data, review and acceptance; RS: study design, data acquisition, interpretation of data, review and acceptance; FC: study design, data acquisition, interpretation of data, review and acceptance; RG: study design, data acquisition, interpretation of data, writing of the first draft of the paper, review and acceptance.

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Correspondence to Piero Ruscitti.

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Conflict of interest

The authors declare that they have no conflicts of interest in this work. Piero Ruscitti: conflict of interest and relationships with pharma agencies—PR received speaker honoraria and/or grants from BMS, MSD, Ely Lilly, SOBI and Pfizer outside this work; Paola Cipriani: conflict of interest and relationships with pharma agencies—PC received speaker honoraria and/or grants from Actelion and Pfizer outside this work; Vasiliki Liakouli: conflict of interest and relationships with pharma agencies—VL received speaker honoraria and/or grants from Sanofi Genzyme and Pfizer outside this work; Daniela Iacono: conflict of interest and relationships with pharma agencies—DI received speaker honoraria from Pfizer, Sanofi Genzyme and BMS outside this work; Ilenia Pantano: conflict of interest and relationships with pharma agencies—none; Francesco Caso: conflict of interest and relationships with pharma agencies—none; Federico Perosa: conflict of interest and relationships with pharma agencies—none; Fabiola Atzeni: conflict of interest and relationships with pharma agencies—none; Francesco Paolo Cantatore: conflict of interest and relationships with pharma agencies—FPC received consultancy fees and/or speaker honoraria from Pfizer, Sanofi Genzyme and Roche outside this work; Raffaelle Scarpa: conflict of interest and relationships with pharma agencies—none; Francesco Ciccia: conflict of interest and relationships with pharma agencies—none; Roberto Giacomelli: conflict of interest and relationships with pharma agencies—RG received speaker honoraria and/or grants from Abbvie, Roche, Actelion, BMS, MSD, Ely Lilly, SOBI and Pfizer outside this work.

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Ruscitti, P., Cipriani, P., Liakouli, V. et al. Prescribing motivations and patients’ characteristics related to the use of biologic drugs in adult-onset Still’s disease: analysis of a multicentre “real-life” cohort. Rheumatol Int 40, 107–113 (2020). https://doi.org/10.1007/s00296-019-04358-w

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