Prolonged treatment with Tadekinig alfa in adult-onset Still’s disease

Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disease, the treatment of which is still not well defined. Biological disease modifying antirheumatic drugs (bDMARDs), including interleukin (IL)-1 and IL-6 antagonists are used empirically in patients refractory to conventional DMARDs.1 This 12-week open-label clinical trial with Tadekinig (recombinant IL-18 binding protein, IL-18BP) showed promising results.2 Herein, we report two patients with AOSD treated successfully with Tadekinig during several months. Case 1 . A 50-year-old patient was diagnosed with AOSD in August 2014 when presenting with arthritis, recurrent fever episodes, sore throat and skin rash. C reactive protein (CRP, 22.9 mg/dL) and ferritin (3568 ng/mL) levels were markedly elevated. Since the initial treatment with prednisolone starting with 100 mg/day and oral methotrexate (MTX) 15 mg/week was insufficient, anakinra was started with 100 mg sc/day and MTX dose was augmented to 25 mg sc/week. High disease activity persisted and prednisolone tapering below 15 mg/day was impossible. As a side effect …