■阻断白细胞介素-1(anakinra和canakinumab)是众所周知的单基因自身炎性疾病(AIDs)的高效工具,比如家族性地中海热,肿瘤坏死因子受体相关周期性综合征,高免疫球蛋白血症D综合征,和冷冻比林相关的周期性综合征,但尚未对未分化AIDs(uAIDs)患者进行评估.我们的研究旨在评估canakinumab对uAIDs患者的安全性和有效性。
■回顾性收集并分析了32例uAIDs患者的信息。下一代测序和Federici标准用于排除已知的单基因AID。
■第一次发作的中位年龄为2.5岁(IQR:1.3;5.5),疾病诊断为5.7年(IQR:2.5;12.7),诊断延迟为1.1年(IQR:0.4;6.1)。患者有以下基因的变异:IL10,NLRP12,STAT2,C8B,LPIN2,NLRC4,PSMB8,PRF1,CARD14,IFIH1,LYST,NFAT5,PLCG2,COPA,IL23R,STXBP2,IL36RN,JAK1,DDX58,LACC1,LRBA,TNFRSF11A,PTHR1,STAT4,TNFRSF1B,TNFAIP3、TREX1和SLC7A7。主要临床特征为发热(100%),皮疹(91%;主要是斑丘疹),关节参与(72%),脾肿大(66%),肝肿大(59%),淋巴结肿大(50%),肌痛(28%),心脏受累(31%),肠道受累(19%);眼睛受累(9%),胸膜炎(16%),腹水(6%),耳聋,脑积水(3%),未能茁壮成长(25%)。canakinumab之前的初始治疗包括非生物疗法:非甾体抗炎药(NSAID)(91%),皮质类固醇(88%),甲氨蝶呤(38%),静脉注射免疫球蛋白(IVIG)(34%),环孢菌素A(25%),秋水仙碱(6%)环磷酰胺(6%),柳氮磺吡啶(3%),霉酚酸酯(3%),羟氯喹(3%),和生物药物:托珠单抗(62%),sarilumab,依那西普,阿达木单抗,利妥昔单抗,英夫利昔单抗(均为3%)。Canakinumab在27例患者(84%)中引起完全缓解,在1例患者(3%)中引起部分缓解。两名患者(6%)是主要的无应答者,两名患者(6%)进一步发展为继发性无效。所有部分疗效或无效的患者均改用托珠单抗(n=4)和sarilumab(n=1)。canakinumab治疗的总持续时间为3.6(0.1;8.7)年。在研究期间,没有报告严重不良事件(SAE)。患者经历了不常见的轻度呼吸道感染,其发生率与施用canakinumab之前相似。此外,一名患者出现白细胞减少症,但该患者没有必要停止canakinumab。
■使用canakinumab治疗uAIDs患者是安全有效的。需要进一步的随机临床试验来确认疗效和安全性。
UNASSIGNED: The blockade of interleukine-1 (anakinra and
canakinumab) is a well-known highly effective tool for monogenic autoinflammatory diseases (AIDs), such as familial Mediterranean fever, tumor necrosis factor receptor-associated periodic syndrome, hyperimmunoglobulinaemia D syndrome, and cryopyrin-associated periodic syndrome, but this treatment has not been assessed for patients with undifferentiated AIDs (uAIDs). Our
study aimed to assess the safety and efficacy of
canakinumab for patients with uAIDs.
UNASSIGNED: Information on 32 patients with uAIDs was retrospectively collected and analyzed. Next-generation sequencing and Federici criteria were used for the exclusion of the known monogenic AID.
UNASSIGNED: The median age of the first episode was 2.5 years (IQR: 1.3; 5.5), that of the disease diagnosis was 5.7 years (IQR: 2.5;12.7), and that of diagnostic delay was 1.1 years (IQR: 0.4; 6.1). Patients had variations in the following genes: IL10, NLRP12, STAT2, C8B, LPIN2, NLRC4, PSMB8, PRF1, CARD14, IFIH1, LYST, NFAT5, PLCG2, COPA, IL23R, STXBP2, IL36RN, JAK1, DDX58, LACC1, LRBA, TNFRSF11A, PTHR1, STAT4, TNFRSF1B, TNFAIP3, TREX1, and SLC7A7. The main clinical features were fever (100%), rash (91%; maculopapular predominantly), joint involvement (72%), splenomegaly (66%), hepatomegaly (59%), lymphadenopathy (50%), myalgia (28%), heart involvement (31%), intestinal involvement (19%); eye involvement (9%), pleuritis (16%), ascites (6%), deafness, hydrocephalia (3%), and failure to thrive (25%). Initial treatment before canakinumab consisted of non-biologic therapies: non-steroidal anti-inflammatory drugs (NSAID) (91%), corticosteroids (88%), methotrexate (38%), intravenous immunoglobulin (IVIG) (34%), cyclosporine A (25%), colchicine (6%) cyclophosphamide (6%), sulfasalazine (3%), mycophenolate mofetil (3%), hydroxychloroquine (3%), and biologic drugs: tocilizumab (62%), sarilumab, etanercept, adalimumab, rituximab, and infliximab (all 3%).
Canakinumab induced complete remission in 27 patients (84%) and partial remission in one patient (3%). Two patients (6%) were primary non-responders, and two patients (6%) further developed secondary inefficacy. All patients with partial efficacy or inefficacy were switched to tocilizumab (n = 4) and sarilumab (n = 1). The total duration of
canakinumab treatment was 3.6 (0.1; 8.7) years. During the
study, there were no reported Serious Adverse Events (SAEs). The patients experienced non-frequent mild respiratory infections at a rate that is similar as before canakinumab is administered. Additionally, one patient developed leucopenia, but it was not necessary to stop canakinumab for this patient.
UNASSIGNED: The treatment of patients with uAIDs using canakinumab was safe and effective. Further randomized clinical trials are required to confirm the efficacy and safety.