Etanercept in the treatment of adult patients with Still's disease

M. Elaine Husni, Harvard Medical School
Agnes L. Maier, Harvard Medical School
Philip J. Mease, Seattle Rheumatology Associates
Steven S. Overman, Minor and James Medical Center
Patricia Fraser, Harvard Medical School
Ellen M. Gravallese, University of Massachusetts Medical School
Michael E. Weinblatt, Harvard Medical School

At the time of publication, Ellen Gravallese was not yet affiliated with the University of Massachusetts Medical School


OBJECTIVE: To evaluate the safety and efficacy of etanercept in the treatment of adult patients with Still's disease.

METHODS: Twelve adult patients who met criteria for Still's disease and had active arthritis were enrolled in a 6-month open-label trial of etanercept given in biweekly doses of 25 mg. The mean disease duration at study entry was 10.7 years. All patients had been treated unsuccessfully with other disease-modifying antirheumatic drugs. Efficacy was evaluated according to American College of Rheumatology (ACR) improvement criteria, and adverse events were recorded.

RESULTS: Ten patients successfully completed the study; 2 withdrew due to disease flare. In 4 patients, the dosage of etanercept was increased from 25 mg biweekly to 25 mg 3 times per week. Seven patients met ACR 20% response criteria. Of these 7 responders, 4 met ACR 50% response criteria and 2 met ACR 70% response criteria. Among the 3 patients with systemic features of Still's disease (fever and rash), improvement in these features was seen in 1; the arthritis did not improve in any of these 3 patients. Except in the 2 patients who withdrew due to disease flare (rash, fever, and arthritis), no other significant adverse events occurred.

CONCLUSION: In this initial study of etanercept therapy for Still's disease in the adult, this treatment resulted in improvement in the arthritis and was well tolerated. Additional trials should be performed to elucidate the effects of tumor necrosis factor inhibitors in Still's disease.