POS1347 IMPACT OF CANAKINUMAB AND ANAKINRA ON PATIENT-REPORTED OUTCOMES IN ADULT-ONSET STILL’S DISEASE PATIENTS
Authors: N. Farina, C. Campochiaro, A. Tomelleri, G. De Luca, G. Cavalli, E. Baldissera, L. Dagna
Journal: Annals of the Rheumatic Diseases (2021)

Background: Adult-onset still’s disease (AOSD) is a rare systemic inflammatory disease. Interleukin-1 (IL1) blockade has shown to be crucial for the management of refractory AOSD patients. The IL1 inhibitors anakinra and canakinumab are both effectively used in clinical practice for the management of AOSD. No data are available on the impact of these therapies on patient-reported outcomes (PROs). Objectives: To assess the impact of ANK and CNK therapies on PROs of AOSD patients. Methods: Medical records of AOSD patients followed up at our Institution who had been treated with both ANK and CNK were identified. Disease features were retrospectively collected. All patients were initially treated with ANK and subsequently with CNK. At the moment of CNK introduction and at their latest visit while on CNK, patients were asked to fill a questionnaire investigating their experience with either ANK or CNK. The questionnaire included 4 different domains that were assessed through means of Visual Analogue Scales (VAS) ranging from 0 to 10. The following domains were considered: injection-related pain, satisfaction with the frequency of administration, concern for drug-related adverse events including infections, and overall drug tolerability. VAS values for each of the domains were compared between ANK and CNK with Mann-Whitney U test. Results: Ten AOSD patients treated with both ANK and CNK were included in the analysis. Disease characteristics are shown in Table 1 below. ANK was discontinued due to inefficacy in 6 patients and due to adverse reactions in 4. As shown in Figure 1, CNK overall tolerability significantly exceeded ANK one ( p =0.021). Only 1 AOSD patient reported a greater tolerability with ANK compared to CNK because she felt more comfortable with pre-filled syringes. The reasons for higher CNK tolerability were the lower pain at injection site (median 1, IQR 1-1 vs median 4.5, IQR 1.25-7; p =0.015) and the greater level of satisfaction with the frequency of administration (median 10, IQR 9.25-10 vs median 3.5, IQR 2.25-4.75, p &lt;0.001). The concern for drug-related adverse events was not significantly different between ANK and CNK ( p =0.549) and overall low among AOSD patients. CNK led to a satisfying control of systemic inflammation and steroid-sparing effect in most of patients and it was discontinued in only one case ( Patient 5 ), due to ineffective disease control. Figure 1. Comparative tolerability of anakinra (blue line) and canakinumab (orange line) in our study population, expressed as Visual Analogue Scale values (range from 1 to 10). Reported p -values refer to the comparative analysis between the two drugs. Conclusion: In our cohort of AOSD patients, CNK proved not only to be effective in controlling systemic inflammation in ANK refractory cases, but its use was associated with greater patients’ satisfaction and tolerability. References: [1]Kluetz et al , Value Health, 2018;21(6):742-747. Table 1. Clinical and treatment characteristics of study population. Sex and age (years ) Disease duration (months ) Disease manifestations Sequential biologic therapies Steroid dosage variation (mg/day ) * ESR variation (mm/hour ) * CRP variation (mg/L ) * Patient 1 Male, 70 22 Arthritis, Fever Rash TCZ, ANK, CNK 25 → 5 120 → 13 55 → 1 Patient 2 Female, 72 11 Arthritis, Fever Rash TCZ, ANK, CNK 5 → 0 60 → 24 265 → 6 Patient 3 Male, 32 48 Fever, Rash ANK, CNK 15 → 0 29 → 11 27 → 1 Patient 4 Male, 71 12 Fever ANK, CNK 20 → 5 120 → 2 180 → 1 Patient 5 Female, 58 72 Fever ANK, CNK 0 → 5 27 → 36 5 → 83 Patient 6 Female, 48 5 Arthritis, Fever Rash ANK, CNK 10 → 0 8 → 10 2 → 1 Patient 7 Female, 74 180 Arthritis, Fever, Rash, MAS ETN, ANK, CNK 5 → 5 33 → 1 1 → 25 Patient 8 Male, 78 180 Arthritis, Fever Rash, Myocarditis Pleuropericarditis ANK, CNK 40 → 20 46 → 10 58 → 40 Patient 9 Male, 22 144 Arthritis, Fever ETN, TCZ, ANK, CNK 20 → 10 86 → 94 135 → 1 Patient 10 Male, 43 24 Arthritis, Fever Rash ANK, CNK 15 → 5 15 → 10 4 → 1 * Before and after canakinumab start. ANK, anakinra; CNK, canakinumab; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ETN, etanercept; MAS, macrophage activation syndrome; MTX, methotrexate; PDN, prednisone; TCZ, tocilizumab. Disclosure of Interests: Nicola Farina: None declared, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Alessandro Tomelleri: None declared, Giacomo De Luca Speakers bureau: SOBI, Novartis, Celgene, MSD, Pfizer, Giulio Cavalli Speakers bureau: SOBI, Elena Baldissera Speakers bureau: Novartis, Pfizer, Roche, Alpha Sigma, Sanofi, Lorenzo Dagna Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, SOBI, Celgene Janssen, MSD, MP