Inhibiting inflammatory cytokines in adult onset Still’s disease. Current trends and new therapeutic perspectives

ABSTRACT

Introduction: Multiple lines of evidence suggest the clinical usefulness of inhibiting inflammatory cytokines in patients affected by adult onset Still’s disease (AOSD), a rare inflammatory disease. The lack of response to the first therapeutic strategy with glucocorticoids and synthetic disease-modifying anti-rheumatic drugs (DMARDs) identifies ‘refractory patients’, to be subsequently treated with biologic DMARDs.

Areas covered: In this article, evidence has been reviewed about the clinical usefulness of biologic DMARDs, targeting inflammatory cytokines, in AOSD, analyzing current trends and suggesting future therapeutic perspectives.

Expert opinion: Therapeutic management of AOSD is directed at targeting inflammatory signs and symptoms, preventing life-threating complications, and minimizing the adverse effects of immunosuppressive therapies. In this context, over the last decade, the clinical usefulness of inhibiting inflammatory cytokines has shown in AOSD with multiple benefits, since a large percentage of patients attain a clinical response. The inhibition of inflammatory cytokines could also be helpful in managing life-threating complications of AOSD. Going forward, this field of research is rapidly growing, and in the next future, the results about ongoing randomized controlled trials and the development of clinical tools readily transferable in clinical practice, would improve the management of AOSD providing more targeted treatment and improving the outcomes of these patients.

KEYWORDS:

• Adult onset still’s disease
• autoinflammatory disease
• biologic drugs
• therapy

Article highlights

• Multiple lines of evidence suggest the clinical usefulness of inhibiting inflammatory cytokines in AOSD.

• Biologic DMARDs largely induce a clinical response and minimise potential risks related to cumulative long-term expose to immunosuppressive drugs.

• IL-1 and IL-6 inhibiting agents are the most common used biologic DMARDs in AOSD in improving systemic and articular symptoms.

• The inhibition of IL-18 could represent a new therapeutic perspective in AOSD.

• Future specific studies are necessary to fully clarify the treatment of AOSD with biologic DMARDs.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.