Interleukin 1 inhibition with anakinra in adult-onset Still disease: a meta-analysis of its efficacy and safety

Abstract

Background

Anakinra is the first interleukin-1 inhibitor to be used in clinical practice, and recent evidence showed that interleukin-1 plays a pivotal role in the pathogenesis of adult-onset Still disease (AoSD). However, data concerning efficacy with anakinra use in different clinical trials has not been evaluated, and the overall remission of AoSD with anakinra treatment has not been well defined.

Methods

We conducted a search on Embase, PubMed, and the Cochrane Library for relevant trials. Statistical analyses were conducted to calculate the overall remission rates, odds ratios (OR), and 95% confidence intervals (CI), by using either random effects or fixed effect models according to the heterogeneity.

Results

Of the 273 articles that were identified, 265 were excluded. Eight studies were eligible for inclusion. The overall remission rate and complete remission rate of anakinra in AoSD patients were 81.66% (95% CI: 69.51%–89.69%) and 66.75% (95% CI: 59.94%–75.3%), respectively. Compared with the controls, the use of anakinra was associated with a significant remission in AoSD, with an OR of 0.16 (95% CI: 0.06–0.44, P=0.0005). There were also significant reductions of the dosage of corticosteroid (mean difference =21.19) (95% CI: 13.2–29.18, P<0.0001) from anakinra onset to the latest follow up time. Clinical and laboratory parameters were all improved, and anakinra was well tolerated in patients with AoSD. No evidence of publication bias was observed.

Conclusion

Our study has shown that anakinra is effective in remitting the manifestations of AoSD, with reduction of the dose of corticosteroid in patients with AoSD. Further, anakinra therapy was not associated with increased risk of adverse events, and it was well tolerated in patients with AoSD. Further research is still recommended to investigate these findings.

Keywords:

• interleukin-1 inhibitor
• AoSD
• anakinra
• adverse events
• clinical and laboratory parameters
• efficacy

Supplementary materials

Figure S1 Electronic search strategy.

Abbreviations: ti, title; ab, abstract; kw, keywords.

Table S1 Quality scores of the studies included in this systematic review

Table S2 PRISMA 2009 checklist

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (grant number 81100277), Zhejiang TCM KEY research fund projects (grant number 2013ZZ009 and 2013ZA078), and the Zhejiang Provincial Education Department Research Fund Project (grant number Y201225107).

Disclosure

The authors report no conflicts of interest in this work.