POS1189 ASSESSMENT OF THE TREATMENT TARGETS FOR STILL’S DISEASE PROPOSED AT EULAR 2023

Background:

In order to achieve the ultimate goal of inactive disease without glucocorticoids, intermediate treatment targets in adult-onset Still's disease have been proposed in EULAR 2023 as part of recommendations for Still's disease. The achievement rate of the targets and prognostic utility in clinical practice need to be further evaluated.

Objectives:

This study aimed to evaluate the achievement rates of the treatment targets for Still's disease proposed in EULAR 2023 and its association with future outcomes.

Methods:

We reviewed consecutive patients diagnosed with adult-onset Still's disease based on the Yamaguchi's criteria and collected medical information. We assessed the achievement rates of the treatment targets from treatment initiation until month 6 and also investigated the association of early target achievement with subsequent achievement of clinically inactive disease and glucocorticoid free.

Results:

Forty-four patients with active adult-onset Still's disease were included in the analysis. The mean age was 52.4±19.5 years, and 34 (77%) were female. At the beginning of treatment, fever was observed in all patients, skin rash in 34 (77%), arthritis in 31 (70%), sore throat in 24 (55%), lymphadenopathy in 18 (41%), hepatosplenomegaly in 16 (36%), and serositis in 6 (14%). The mean CRP level was 11.7±8.6 mg/dL, and the median serum ferritin level was 4506 ng/mL. The mean initial dose of prednisolone was 48.3±23.4 mg/day. The recommended intermediate treatment targets were achieved in 63% at day 7, 57% at week 4, 14% at month 3, and 2% at month 6. Failure to achieve targets at month 3 and 6 was mainly due to glucocorticoid dose (Table 1). Baseline characteristic of the 26 patients who achieved the targets at day 7 were not significantly different from those of the 15 patients who did not achieve the day 7 targets (CRP levels, 11.4±7.9 mg/dL vs 13.0±10.3 mg/dL, p=0.564; ferritin levels, 3950 ng/mL vs 6477 ng/mL, p=0.170; glucocorticoid dose, 52.3±27.2 mg/day vs 44.7±13.2 mg/day, p=0.232, respectively). Patients who achieved day 7 targets were likely to achieve month 3 and 6 target than those who did not achieve day 7 target (clinical inactive disease at month 3, 77% vs 47%, p=0.049; prednisolone <0.2 mg/kg/day at month 6, 62% vs 14%, p=0.007, figures).

Conclusion:

Intermediate treatment targets for Still's disease proposed at EULAR 2023 were achieved in more than half of patients at day 7 and week 4, but only in less than 20% at month 3 and month 6, mainly because of glucocorticoid dose. Patients who achieved the targets at day 7 had favorable outcomes thereafter, suggesting the usefulness of the proposed intermediate treatment targets in clinical practice.

REFERENCES:

NIL. Table 1.

Acknowledgements:

NIL.

Disclosure of Interests:

Hiroya Tamai AbbVie, Eisai, Sora Ito: None declared, Satoshi Takanashi Bristol Myers Squibb, Yuko Kaneko AbbVie, Asahi Kasei, Astellas, AstraZeneca, Ayumi, Bristol Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Glaxo Smith Kline, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, Taisho, UCB, Asahi Kasei, AbbVie, Ayumi, Boehringer-Ingelheim, Chugai, Eisai, Gilead, Mitsubishi-Tanabe, Taisho, UCB.