Biologic DMARDs Show Superior Outcomes as First-Line Therapy in Adult-Onset Still’s Disease
A multicenter retrospective cohort study from Germany provides new evidence supporting the use of biologic disease-modifying antirheumatic drugs (DMARDs) as first-line therapy in patients with adult-onset Still’s disease (AOSD). The findings, published in The Lancet Rheumatology, suggest that initiating treatment with biologic DMARDs is associated with higher rates of sustained, event-free remission and fewer treatment-related complications compared to conventional synthetic DMARDs.
The study included 86 treatment-naive patients with AOSD from 16 rheumatology centers, all of whom met the Yamaguchi classification criteria. Of the cohort, 44 patients (51%) received first-line biologic DMARD therapy—including anakinra, canakinumab, or tocilizumab—and 42 (49%) received conventional synthetic DMARDs, primarily methotrexate or glucocorticoids.
The primary endpoint was sustained, event-free remission at 72 weeks, defined as a C-reactive protein (CRP) level under 10 mg/L and absence of arthritis, rash, or fever, with no recorded complications. The biologic DMARD group achieved significantly higher remission rates than the conventional therapy group. “Biological DMARD therapy was associated with a greater likelihood of reaching the primary endpoint of sustained, event-free remission (OR 7.20, 95% CI 2.50–36.64; p=0.0007),” the authors reported.
At week 72, 50% of patients treated with biologic DMARDs met the criteria for sustained, event-free remission, compared to only 12% in the conventional therapy group. Notably, no patients in the biologic DMARD group experienced glucocorticoid-related complications, while 5 patients in the conventional group developed new adverse events, including hypertension and steroid-induced skin conditions.
Additionally, 3 deaths occurred in the conventional therapy group—2 attributed to macrophage activation syndrome and 1 of unknown cause—while no deaths were reported in the biologic DMARD group.
“These findings highlight the potential of biologics to improve patient outcomes compared with conventional treatment options in AOSD,” the authors concluded.
For practicing rheumatologists, the study underscores the potential benefits of re-evaluating treatment algorithms in AOSD and considering biologic agents earlier in the course of disease.
Reference
Kernder A, Filla T, Friedrich R, et al. First-line biological versus conventional synthetic disease-modifying antirheumatic drug therapy in adult-onset Still’s disease: a multicentre, retrospective, propensity weighted cohort study. The Lancet Rheumatology. March 2025. doi:10.1016/s2665-9913(25)00023-2
