POS1193 EFFICACY AND SAFETY OF BIOLOGICAL DRUGS IN THE TREATMENT OF PEDIATRIC AND ADULT PATIENTS WITH STILL’S DISEASE: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: B. Kilic, A. Ozturk, S. Karup, E. Hacioglu, S. Ugurlu
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Still's disease is a rare autoinflammatory disorder characterized by systemic inflammation, spiking fever, evanescent rash, arthralgia, and arthritis and encompasses both systemic Juvenile Idiopathic Arthritis (sJIA) and adult-onset Still's Disease (AOSD). sJIA affects children, whereas AOSD occurs in adults, making them distinct clinical entities based on the age of onset. However, these conditions share substantial similarities, encouraging researchers and medical specialists to consider AOSD as the adult equivalent of sJIA. Biological drugs, including anti-interleukin-1 agents anakinra, canakinumab, rilonacept, and the interleukin-6 antagonist tocilizumab, are being used in the management of Still's disease. <h3>Objectives:</h3> This study aimed to investigate the best treatment modalities for Still's disease across different age groups according to the principles of evidence-based medicine. <h3>Methods:</h3> Our systematic review was conducted in accordance with the PRISMA 2020 Statement and the study protocol was registered on The International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023450442. MEDLINE (via PubMed), EMBASE, and CENTRAL were screened from the earliest record until August 17, 2023. We included pediatric and adult patients with a diagnosis of Still's disease according to ILAR and Yamaguchi criteria, respectively. Patients who received a placebo or one of the biological agents including, anakinra, canakinumab, rilonacept, and tocilizumab were eligible for inclusion. In terms of study design, only randomized controlled trials were included. The primary efficacy and safety outcomes were the achievement of ACR50 response and the occurrence of serious adverse events, respectively. We conducted a pairwise meta-analysis to assess the efficacy and safety of the included interventions individually. To evaluate the comparative efficacy and tolerability, a multivariate meta-analysis was performed. The interventions were ranked using rankograms and SUCRA values. <h3>Results:</h3> Nine randomized controlled trials with 430 patients were included. All biological drugs were associated with greater odds of ACR50 response compared with placebo. There was no statistically significant association between biological drugs and the occurrence of serious adverse events. The multivariate meta-analysis found no significant difference between the included biological drugs in terms of ACR50 response and occurrence of serious adverse events (Figure 1). The most effective intervention in achieving ACR50 response as per SUCRA and mean rank values was anakinra, followed by canakinumab, tocilizumab, rilonacept, and placebo. The SUCRA ranking and mean rank values indicated that anakinra was the safest option among the included drugs, followed by placebo, rilonacept, canakinumab, and tocilizumab (Figure 2). Injection site reactions were the most frequently reported AEs in patients receiving anakinra. Upper respiratory tract infections, pharyngitis, and abdominal pain were notably frequent in the patients who received canakinumab. Pharyngitis, upper respiratory tract infections, and headache were commonly reported during tocilizumab treatment. The reported AEs were often mild and did not lead to drug discontinuation. <h3>Conclusion:</h3> This study was the first meta-analysis to evaluate the safety and efficacy of biological drugs for Still's disease, according to the framework set by the concept of a single disease continuum.as recommended in the most recent EULAR congress. Biological drugs were effective in achieving ACR response and demonstrated a low adverse event profile in patients with Still's disease. Anakinra may be the drug of choice among other biological agents in terms of efficacy and tolerability. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>