2019 Volume 31 Issue 4 Pages 300-306
Tocilizumab（TCZ）is reported to be effective for the treatment of adult Still’s disease（ASD）; However, some reports warn that TCZ can cause macrophage activation syndrome（MAS）in ASD. Consequently, further investigation of TCZ therapy for patients with ASD is required. The current retrospective study evaluated the use of high-dose steroid and TCZ in seven cases of ASD between 2016 and 2017. We specifically focused on clinical change over the first three months of TCZ treatment. The median age was 44 years（inter quartile range 41-59）. Of the total participants, three were males. Additionally, out of the total, five cases were newly diagnosed, and two were recurrent. In all the cases, the steroid dose was rapidly tapered and 8 mg/kg of TCZ was administered intravenously every 1–6 weeks to ensure remission. TCZ was discontinued after the third administration in one case due to intra-abdominal infection. Transient thrombocytopenia, frequently accompanied by elevated serum ferritin levels was observed in six cases after the first or second TCZ administration. However, this side effect improved with no further serious adverse events such as MAS. Therefore, TCZ was not stopped and the steroid dose was not increased.
These results demonstrated that TCZ treatment is very effective for tapering the steroid dose in refractory or severe ASD. Although thrombocytopenia and elevated serum ferritin levels frequently occur after introducing TCZ, these symptoms improved and did not require withdrawal from TCZ.
