The reduction of concomitant glucocorticoids dosage following treatment with IL-1 receptor antagonist in adult onset Still's disease. A systematic review and meta-analysis of observational studies

Background: Despite being burdened by significant adverse events, glucocorticoids (GCs) are frequently employed in managing adult onset Still's disease (AOSD), prompting the need for GC-sparing agents. In this work, we performed a systematic review and meta-analysis to synthesize the evidence about the reduction of concomitant GCs dosage and the rate of GCs discontinuation in patients with AOSD who were treated with anakinra, a recombinant IL-1 receptor antagonist.Methods: A systematic review of the literature was completed to identify all available data concerning the reduction of concomitant GCs dosage following anakinra in AOSD and a meta-analysis was thus performed using a random-effects model.Results: A significant reduction of the GCs dosage was detected by pooled analysis with mean difference of -22.4 mg/day [95% confidence interval (CI): -28.8 to -16.1, p< 0.0001] at the last follow-up; the heterogeneity was moderate (Q=11.67 with df= 7.00, p< 0.0001, I-2 =40.01%). Furthermore, the pooled analysis under a random effects model showed an overall rate of GCs discontinuation of 0.35 (95% CI: 0.28-0.41, p < 0.0001); the heterogeneity was low (Q=5.99 with df=6.00, p <0.0001, I-2 =0.00%).Discussion: Taking together all these findings, the reduction of concomitant GCs dosage following anakinra could be suggested, leading to a further improvement of AOSD therapeutic strategy.Conclusion: In conclusion, the present systematic review and meta-analysis suggests the reduction of concomitant GCs dosage following treatment with anakinra. A percentage of patients are no longer required to be treated with GCs, discontinuing these drugs without a flare of the disease.