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ETANERCEPT IN RECALCITRANT ADULT ONSET STILL'S DISEASE (AOSD).

Eric R Tamesis, Anthony M Reginato, Oswaldo Hubscher, Antonio J Reginato
Camden, NJ; Boston, MA and Buenos Aires, Argentina

Objective:To describe the effect of Etanercept in the management of 5 Pts.
with recalcitrant AOSD.

Patient-Methods: Five Pts. with severe AOSD fulfilling the classification criteria of Yamaguchi et al. who have not responded to several combinations of second line drugs (hydroxychloroquine, azulfidine, methotrexate,
cyclosporine, azathioprine and/or IV gammaglobulin) were managed with
etanercept 25 mg twice a week. Prior to the use of etanercept, every Pt. was receiving prednisone between 30 to 60 mg/d. Ages ranged from 35 to 42 years, four were women. Pt. [pound]1 has a 3-year history of persistent daily fever up to 104 F with mesenteric lymphadenitis, myalgias and arthritis. Pt.
[pound]2 has a five-year history of persistent rash, fever, and symmetric chronic polyarthritis. Pt. [pound]3 had a progressive arthropathy of hands, shoulders, rash, and fever with severe Jaccoud-like arthropathy. Pt.
[pound]4 had persistent fever, erosive polyarthritis and multiple compression fractures. Etanercept administration periods ranged from 6 weeks to one year.

Results: Fever, joint pains, myalgias, synovitis and skin rash showed a significant improvement after 3 weeks of etanercept administration in all five Pts. Pt. [pound]1 expired 6 weeks later of an unexplained sudden death while she was still receiving high doses of prednisone. The remaining 4 Pts. have completed 6 to 12 months of etanercept therapy, all are in clinical
remission and receiving lower prednisone doses (7.5 to 10 mg). Pt. [pound]2
presented with an episode of cellulitis away from the injection sites and this subsided with antibiotics.

Conclusion: Short term etanercept administration was effective in controlling fever, polyarthritis, and rashes on 5 pts. with recalcitrant AOSD, further studies are necessary to investigate its long term effect and side effects.


Disclosure: Speaker Bureau of PANLAR, Merck, Pfizer

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