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Kilic Konte E, Akay N, Gul U, Ucak K, Derelioglu EI, Gurleyik D, Aslan E, Gunalp A, Haslak F, Yildiz M, Adrovic A, Sahin S, Barut K, Kasapcopur O. Long-term safety profile and secondary effectiveness of canakinumab in pediatric rheumatic diseases: a single-center experience. Expert Opin Drug Saf 2024:1-9. [PMID: 39069814 DOI: 10.1080/14740338.2024.2386370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND To demonstrate the long-term safety profile of canakinumab over a nine-year period by documenting adverse events in patients with various pediatric rheumatic diseases. RESEARCH DESIGN AND METHODS This retrospective observational study was conducted at the Pediatric Rheumatology Department of Istanbul University Cerrahpasa between 2015 and 2023. The analysis concerned individuals who had been administered canakinumab treatment for at least six months. The exposure-adjusted event rates were calculated as adverse events per 100 patient days and were compared among three groups based on the cumulative canakinumab dose of <35 mg/kg, 35-70 mg/kg, and >70 mg/kg. RESULTS Among 189 patients, the median exposure time to canakinumab was 2.9 (1.5-4.1) years, corresponding to 573.4 patient years. The median cumulative dose of canakinumab was 2205 (1312-3600) mg. The most common adverse event was upper respiratory tract infection (0.76), followed by urinary tract infection (0.02), pneumonia (0.009), latent tuberculosis (0.009) and lymphadenitis (0.004). A total of 55 serious adverse events (0.025) were reported, 12 (0.006) of which led to drug discontinuation. The event rate of macrophage activation syndrome and disease exacerbation was statistically higher in patients receiving <35 mg/kg cumulative canakinumab dose (p < 0.05). CONCLUSIONS An increase in side effect was not observed with the increasing cumulative doses of canakinumab. Canakinumab demonstrated long-term safety with appropriate indication and monitoring.
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Affiliation(s)
- Elif Kilic Konte
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nergis Akay
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Umit Gul
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kubra Ucak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ecenur Izzete Derelioglu
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Damla Gurleyik
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esma Aslan
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybuke Gunalp
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Haslak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Kuemmerle-Deschner JB, Kallinich T, Henes J, Kortus-Götze B, Oommen PT, Rech J, Krickau T, Weller-Heinemann F, Horneff G, Janda A, Foeldvari I, Schuetz C, Dressler F, Borte M, Hufnagel M, Meier F, Fiene M, Andreica I, Weber-Arden J, Blank N. Long-term safety and effectiveness of canakinumab in patients with monogenic autoinflammatory diseases: results from the interim analysis of the RELIANCE registry. RMD Open 2024; 10:e003890. [PMID: 38360038 PMCID: PMC10875478 DOI: 10.1136/rmdopen-2023-003890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Interim analysis of the RELIANCE registry, an on-going, non-interventional, open-label, multicentre, prospective study evaluating the long-term safety, dosing regimens and effectiveness of canakinumab in patients with cryopyrin-associated periodic syndromes (CAPS), familial Mediterranean fever (FMF), tumour-necrosis factor receptor-associated periodic syndrome (TRAPS) or mevalonate-kinase deficiency (MKD)/hyperimmunoglobulin-D syndrome (HIDS). METHODS From September 2017 for patients with CAPS, and June 2018 for patients with FMF, TRAPS or MKD/HIDS, the registry enrolled paediatric (aged ≥2 years) and adult patients (aged ≥18 years) receiving canakinumab as part of their routine medical care. Safety, canakinumab dose, disease activity and quality of life outcome measures were evaluated at baseline and every 6 months until end of study visit. RESULTS At the analysis cut-off date (December 2020), 168 patients (91 CAPS, 54 FMF, 16 TRAPS and 7 MKD/HIDS) were enrolled. 85 (50.9%) patients were female and 72 (43.1%) were children (<18 years). The median patient age was 20.0 years (range 2.0-79.0 years). In the CAPS cohort, serious infections and serious adverse drug-reactions were more common in patients receiving higher than the recommended starting dose (SD) of canakinumab. A trend to receive >SD of canakinumab was observed in the pooled population. The majority of patients were reported as having either absent or mild/moderate disease activity (physician's global assessment) from baseline to Month 30, with a stable proportion of patients (~70%) in remission under canakinumab treatment. Patient-reported disease activity (Visual Analogue Scale (VAS), Autoinflammatory Disease Activity Index), fatigue (VAS); markers of inflammation (C-reactive protein, serum amyloid A and erythrocyte sedimentation rate) remained well-controlled throughout. CONCLUSION Data from this analysis confirm the long-term safety and effectiveness of canakinumab for the treatment of CAPS, FMF, TRAPS and MKD/HIDS.
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Affiliation(s)
- Jasmin B Kuemmerle-Deschner
- Division of Paediatric Rheumatology and autoinflammation reference centre Tübingen, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Tilmann Kallinich
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin and Deutsches Rheuma-Forschungszentrum (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - Joerg Henes
- Center of Interdisciplinary Rheumatology, Immunology and autoimmune diseases (INDIRA), University Hospital Tübingen, Tübingen, Germany
| | - Birgit Kortus-Götze
- Department of Internal Medicine, Division of Nephrology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Prasad T Oommen
- Department of Paediatric Oncology, Haematology and Clinical Immunology, Division of Paediatric Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Juergen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- DZI (Deutsches Zentrum für Immuntherapie), Erlangen, Germany
- Centre for Rare Diseases Erlangen (ZSEER), Erlangen, Germany
| | - Tobias Krickau
- DZI (Deutsches Zentrum für Immuntherapie), Erlangen, Germany
- Centre for Rare Diseases Erlangen (ZSEER), Erlangen, Germany
- Department of Pediatric Rheumatology, University Hospital Erlangen, Erlangen, Germany
| | | | - Gerd Horneff
- Department of Paediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany
- Department of Paediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Aleš Janda
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Ulm, Ulm, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Paediatric and Adolescence Rheumatology, Hamburg, Germany
| | - Catharina Schuetz
- Department of Paediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Frank Dressler
- Department of Paediatric Pneumonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Michael Borte
- Hospital for Children & Adolescents, St. Georg Hospital, Leipzig, Germany
- Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Markus Hufnagel
- Division of Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Florian Meier
- Department of Medicine II, Rheumatology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael Fiene
- Rheumazentrum Greifswald, Greifswald, Germany
- Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Paediatrics, Erlangen, Germany
| | - Ioana Andreica
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Norbert Blank
- Division of Rheumatology, Department of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany
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3
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Georgin-Lavialle S, Savey L, Cuisset L, Boursier G, Boffa JJ, Delplanque M, Bourguiba R, Monfort JB, Touitou I, Grateau G, Kone-Paut I, Hentgen V. French protocol for the diagnosis and management of familial Mediterranean fever. Rev Med Interne 2023; 44:602-616. [PMID: 37903671 DOI: 10.1016/j.revmed.2023.10.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 11/01/2023]
Abstract
Familial Mediterranean fever is the most common monogenic auto-inflammatory disease in the world. It mainly affects people originating from the Mediterranean region. The mutated gene is MEFV, which codes for pyrin. Transmission is autosomal recessive. Patients present with recurrent attacks of fever since childhood associated with abdominal and/or thoracic pain lasting an average of 2-3days and a biological inflammatory syndrome. Other symptoms include arthralgia or arthritis in large joints such as the knees and ankles, myalgia in the lower limbs and pseudo-erysipelas in the ankles. The most serious complication is inflammatory amyloidosis, which can lead to kidney failure. Treatment is based on colchicine, which helps to prevent flares and the onset of renal amyloidosis. This paper proposes national guidelines for the diagnosis, management and follow-up of familial Mediterranean fever in France, where we estimate there are between 5000 and 10,000 patients with the disease at all stages of life. The diagnosis is suspected on the basis of clinical and anamnestic factors and confirmed by genetic analysis. These guidelines also suggest a "treat-to-target" approach to disease management, particularly in case of suspected colchicine resistance - a very rare situation that should remain a diagnosis of elimination, especially after colchicine compliance has been verified. Two special situations are also addressed in these guidelines: kidney failure and pregnancy.
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Affiliation(s)
- S Georgin-Lavialle
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France.
| | - L Savey
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - L Cuisset
- Genetics, Cochin Hospital, Paris, France
| | - G Boursier
- Genetics, Montpellier University, Montpellier, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - J-J Boffa
- Nephrology, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - M Delplanque
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - R Bourguiba
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - J-B Monfort
- Dermatology, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - I Touitou
- Genetics, Montpellier University, Montpellier, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - G Grateau
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - I Kone-Paut
- Rhumatopediatry, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - V Hentgen
- Paediatric Rheumatology, Versailles Hospital, Versailles, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
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4
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Ehlers L, Rolfes E, Lieber M, Müller D, Lainka E, Gohar F, Klaus G, Girschick H, Hörstermann J, Kümmerle-Deschner J, Brunner J, Palm-Beden K, Tenbrock K, von Wrangel L, Faßhauer M, Blank N, Trauzeddel R, von Stuckrad ASL, Higgins S, Welzel T, Lutz T, Hentgen V, Foell D, Wittkowski H, Kallinich T. Treat-to-target strategies for the management of familial Mediterranean Fever in children. Pediatr Rheumatol Online J 2023; 21:108. [PMID: 37752496 PMCID: PMC10521475 DOI: 10.1186/s12969-023-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/11/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The objective of this initiative was to develop a treat-to-target (T2T) approach for the management of patients with Familial Mediterranean Fever (FMF), including the definition of a complex treatment target, and establish strategies that improve patient care and long-term outcome. METHODS An initial set of statements as well as a flow chart visualising the proposed concept was developed. To adapt the preliminary statements to the current state of knowledge, a systematic literature search was performed and the modified statements were subject to a Delphi approach. To ensure the applicability of the statements in daily practice, an online survey was conducted among paediatric rheumatologists in Germany. In addition, data from the national AID-NET registry were analysed with respect to therapeutic response. RESULTS This T2T initiative yielded a total of 26 statements guiding FMF management with respect to diagnosis, treatment targets, treatment strategies and monitoring. The online survey identified cut-off values for inflammatory markers indicating treatment intensification and appropriate measures in case of colchicine intolerance or non-adherence. The analysis of data derived from the national AID-NET showed that colchicine therapy was successfully terminated in 61% of patients (27 out of 44) with heterozygous MEFV mutations. Multidimensional treatment targets incorporating objective and subjective reported outcome measures were developed. These provide the basis for stratifying patients into the following treatment paths: continue colchicine, persisting attacks / inflammation, colchicine intolerance, persisting arthritis, colchicine reduction and adjustment/reduction of biologics. CONCLUSIONS The proposed consensus treatment plan for the management of FMF incorporates multidimensional targets allowing transparent treatment decisions, which will promote personalised disease management and increase adherence to therapy.
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Affiliation(s)
- Lisa Ehlers
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elisabeth Rolfes
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mareike Lieber
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Müller
- Department of Paediatrics, Division of Gastroenterology, Nephrology and Metabolic Diseases, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elke Lainka
- Department of Paediatrics II, University Hospital Essen, Children's Hospital, Essen, Germany
| | - Faekah Gohar
- Clinic of Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Günter Klaus
- KfH Center of Paediatric Nephrology, Department of Paediatric Nephrology, Marburg, Germany
| | - Hermann Girschick
- Vivantes Klinikum Friedrichshain, Children's Hospital, Berlin, Germany
| | - Jana Hörstermann
- Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Jasmin Kümmerle-Deschner
- Autoinflammation Reference Center Tübingen (arcT), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen Brunner
- Department of Paediatrics, Medical University Innsbruck, Danube Private University, Innsbruck, Krems, Austria
| | - Katharina Palm-Beden
- Clinic of Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Klaus Tenbrock
- Department of Paediatric Pneumology, Allergology and Immunology, RWTH Aachen, Aachen, Germany
| | | | - Maria Faßhauer
- ImmunoDeficiencyCenter Leipzig (IDCL), Hospital St. Georg GmbH Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Norbert Blank
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ralf Trauzeddel
- Department of Paediatrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anne Sae Lim von Stuckrad
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sonja Higgins
- Paediatric medical practice Hürthpark, Hürth, Germany
| | - Tatjana Welzel
- Autoinflammation Reference Center Tübingen (arcT), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
- Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University Basel, Basel, Switzerland
| | - Thomas Lutz
- Center for Rheumatology, Paediatric Rheumatology, Heidelberg, Germany
| | - Véronique Hentgen
- Department of Paediatrics, National Reference Center for Auto-inflammatory Diseases and Amyloidosis, CEREMAIA, Versailles Hospital, Versailles, France
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Helmut Wittkowski
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Tilmann Kallinich
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
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5
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Welzel T, Oefelein L, Twilt M, Pfister M, Kuemmerle-Deschner JB, Benseler SM. Tapering of biological treatment in autoinflammatory diseases: a scoping review. Pediatr Rheumatol Online J 2022; 20:67. [PMID: 35964053 PMCID: PMC9375310 DOI: 10.1186/s12969-022-00725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biological treatment and treat-to-target approaches guide the achievement of inactive disease and clinical remission in Autoinflammatory Diseases (AID). However, there is limited evidence addressing optimal tapering strategies and/or discontinuation of biological treatment in AID. This study evaluates available evidence of tapering biological treatment and explores key factors for successful tapering. METHODS A systematic literature search was conducted in Embase, MEDLINE, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials using the OVID platform (1990-08/2020). Bibliographic search of relevant reviews was also performed. Studies/case series (n ≥ 5) in AID patients aged ≤ 18 years with biological treatment providing information on tapering/treatment discontinuation were included. After quality assessment aggregated data were extracted and synthesized. Tapering strategies were explored. RESULTS A total of 6035 records were identified. Four papers were deemed high quality, all focused on systemic juvenile idiopathic arthritis (sJIA) (1 open-label randomized trial, 2 prospective, 1 retrospective observational study). Biological treatment included anakinra (n = 2), canakinumab (n = 1) and tocilizumab (n = 1). Strategies in anakinra tapering included alternate-day regimen. Canakinumab tapering was performed randomized for dose reduction or interval prolongation, whereas tocilizumab was tapered by interval prolongation. Key factors identified included early start of biological treatment and sustained inactive disease. CONCLUSION Tapering of biological treatment after sustained inactive disease should be considered. Guidance for optimal strategies is limited. Future studies may leverage therapeutic drug monitoring in combination with pharmacometric modelling to further enhance personalized "taper-to-target" strategies respecting individual patients and diseases aspects.
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Affiliation(s)
- Tatjana Welzel
- Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), Department of Pediatrics, Member of the European Reference Network for rare or low prevalence complex diseases, network Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA), University Children`s Hospital Tuebingen, Tuebingen, Germany. .,Pediatric Pharmacology and Pharmacometrics, Pediatric Rheumatology, University Children`s Hospital Basel (UKBB), University of Basel, Spitalstrasse 33, CH, 4031, Basel, Switzerland.
| | - Lea Oefelein
- grid.488549.cPediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), Department of Pediatrics, Member of the European Reference Network for rare or low prevalence complex diseases, network Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA), University Children`s Hospital Tuebingen, Tuebingen, Germany
| | - Marinka Twilt
- grid.22072.350000 0004 1936 7697Rheumatology, Department of Pediatrics, Alberta Children`s Hospital, Cumming School of Medicine, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada
| | - Marc Pfister
- grid.412347.70000 0004 0509 0981Pediatric Pharmacology and Pharmacometrics, Pediatric Rheumatology, University Children`s Hospital Basel (UKBB), University of Basel, Spitalstrasse 33, CH 4031 Basel, Switzerland
| | - Jasmin B. Kuemmerle-Deschner
- grid.488549.cPediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), Department of Pediatrics, Member of the European Reference Network for rare or low prevalence complex diseases, network Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA), University Children`s Hospital Tuebingen, Tuebingen, Germany
| | - Susanne M. Benseler
- grid.22072.350000 0004 1936 7697Rheumatology, Department of Pediatrics, Alberta Children`s Hospital, Cumming School of Medicine, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada
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Systemic Autoinflammatory Diseases: A Growing Family of Disorders of Overlapping Immune Dysfunction. Rheum Dis Clin North Am 2021; 48:371-395. [PMID: 34798958 DOI: 10.1016/j.rdc.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Systemic autoinflammatory diseases (SAIDs) are characterized by unprovoked exaggerated inflammation on a continuum from benign recurrent oral ulceration to life-threatening strokes or amyloidosis, with renal failure as a potential sequela. The ability to discriminate these diagnoses rests on the genetic and mechanistic defect of each disorder, considering potential overlapping autoinflammation, autoimmunity, and immune deficiency. A comprehensive and strategic genetic investigation influences management as well as the consequential expected prognoses in these subsets of rare diseases. The ever-expanding therapeutic armamentarium reflects international collaborations, which will hasten genetic discovery and consensus-driven treatment.
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