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Journal Article Ahead of print 1 citation

PubMed: 42364377 DOI: 10.1016/j.semarthrit.2026.153030

Long-term remission and monocyclic course in Still's disease patients starting canakinumab early: data from the international AIDA network registry.

Semin Arthritis Rheum 80:153030

Authors: Antonio Vitale, Valeria Caggiano, Jessica Sbalchiero, Giuseppe Lopalco, Abdurrahman Tufan, Gaafar Ragab, Petros P Sfikakis, Lorenzo Dagna, Ezgi Deniz Batu, Seza Ozen, Fabrizio Conti, Federica Maiolini, Serena Bugatti, Micol Frassi, Piero Ruscitti, Andrea Cito, Ibrahim Yahya Cakir, Nergis Akay, Elif Kilic Konte, Katerina Laskari, Hulya Ercan Emreol, Roberta Priori, Jacopo Croce, Ludovico De Stefano, Crisafulli Francesca, Paola Cipriani, Francesco La Torre, Maria Cristina Maggio, Sulaiman M Al-Mayouf, Lampros Fotis, Donato Rigante, Elena Verrecchia, Giuliana Guggino, Lidia La Barbera, Matteo Piga, Giacomo Emmi, Romina Gallizzi, Giovanni Conti, Paolo Sfriso, Elena Bartoloni, Roberto Giacomelli, Patrizia Barone, Maria Francesca Gicchino, Annachiara Alemanno, Alberto Lo Gullo, Haner Direskeneli, Fatma Alibaz-Oner, Anastasios Karamanakos, Marcella Prete, Amr Edrees … and 41 other authors

Affiliations

  • Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Italy.
  • Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy; Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Italy.
  • Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy.
  • Gazi University Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.
  • Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt.
  • Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Athens, Greece.
  • Faculty of Medicine, Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey.
  • Department of Internal Medicine and Medical Specialties, Rheumatology Unit, AOU Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00185 Rome, Italy.
  • Unit of Internal Medicine B, Department of Medicine, Università degli Studi di Verona, Verona, Italy.
  • Department of Internal Medicine and Therapeutics, Università di Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy.
  • Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy.
  • Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
  • Department of Paediatrics, Division of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Faculty of Medicine, Istanbul, Turkey.
  • Department of Pediatrics, Pediatric Rheumatology Center (F.L.T.), Giovanni XXIII Pediatric Hospital, University of Bari Aldo Moro, Bari, Italy.
  • University Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy.
  • Department of Pediatrics, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
  • Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, Greece.
  • Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Periodic Fever Research Center, Università Cattolica Sacro Cuore, Rome, Italy.
  • Periodic Fever Research Center, Università Cattolica Sacro Cuore, Rome, Italy; Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Italy.
  • Rheumatology Unit, Department of Medical Sciences and Public health, University and AOU of Cagliari, Cagliari, Italy.
  • Department of Medical, Surgical and Health Sciences, University of Trieste, Italy, and Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy; Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC, Australia.
  • Pediatric Rheumatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy.
  • Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliero Universitaria (AOU) G Martino, Messina, Italy.
  • Rheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy.
  • Rheumatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
  • Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Rome, Italy; Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  • Pediatric Rheumatology Unit, Department of Integrated Maternal-Child and Reproduction Activity, AOU "Policlinico-San Marco", Catania, Italy.
  • Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
  • Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy.
  • Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey.
  • Department of Rheumatology, "Evangelismos" General Hospital, Athens, Greece.
  • Rheumatic and Systemic Autoimmune Diseases Unit, Department of Interdisciplinary Medicine (DIM), University of Bari Medical School, Bari, Italy.
  • Division of Rheumatology, University of Missouri, Kansas City, Missouri, USA.

Abstract

OBJECTIVES

To evaluate whether early canakinumab initiation may provide treatment advantages in Still's disease (SD) patients, particularly in terms of therapy discontinuation due to long-term disease remission, glucocorticoid sparing effect, and increase in the frequency of monocyclic disease course rather than a polycyclic or chronic articular pattern.

METHODS

SD patients treated with canakinumab were grouped according to time between disease onset and canakinumab initiation (≤3 months vs. >3 months). Patients were enrolled from the international AutoInflammatory Disease Alliance (AIDA) Network registry for SD.

RESULTS

Overall, 190 patients were enrolled, 35 (19%) treated with canakinumab within three months from SD onset and 155 (82%) starting canakinumab later. Glucocorticoids use decreased more rapidly in patients receiving canakinumab within 3 months from SD onset than among patients treated later, with reductions of 50% vs 6% at month 3 (p=0.0001), and 75% vs 32% at month 6 (p=0.004). In logistic regression analysis, canakinumab initiation within 3 months from disease onset was significantly associated with treatment discontinuation due to long-term remission (OR 4.83, 95% CI 1.08-23.19; p=0.04). A monocyclic course occurred in 49% of patients starting canakinumab ≤3 months versus 8% starting later (p<0.0001). Starting canakinumab within 3 months from disease onset was significantly associated with a monocyclic disease course compared with the chronic-articular (RRR 4.43, 95% CI 1.12-17.60; p=0.034) and polycyclic courses (RRR 8.97, 95% CI 1.29-62.3; p=0.03).

CONCLUSIONS

Early canakinumab initiation is associated with treatment discontinuation due to long-term remission and appears linked to a greater frequency of a monocyclic disease course.

MeSH

Registries, Glucocorticoids, Arthritis, Rheumatic Diseases, Therapeutics