TOPLINE

First-line biologics resulted in higher sustained event-free remission in adult-onset Still disease than methotrexate (MTX), calcineurin inhibitors (CNI), and JAK inhibitors at 72 weeks, with benefits extending to long-term glucocorticoid discontinuation vs MTX and CNI in a two-center cohort study.

METHODOLOGY

• Researchers conducted a retrospective, propensity-weighted cohort study involving 124 patients with adult-onset Still disease from two centers: China (n = 96; mean age at inclusion, 40.8 years; 86% women) and Germany (n = 28; 17 women). Data were collected from January 2024 to July 2025.
• Patients who met the Yamaguchi criteria for active adult-onset Still disease and had complete longitudinal data were included; outcomes were assessed at baseline, week 12, and week 72. Patients in the German cohort received anakinra as first-line biologic treatment.
• Patients were categorized into four treatment groups: MTX (n = 30); CNI, including cyclosporine or tacrolimus (n = 31); JAK inhibitors, including tofacitinib or baricitinib (n = 23); and biologics, including anakinra or tocilizumab (n = 40). Overlap weighting of propensity scores was applied.
• The primary outcome was sustained event-free remission between weeks 12 and 72, defined as clinical and biochemical quiescence (C-reactive protein levels < 10.0 mg/L and no arthritis, rash, or fever), and events comprised major treatment- or disease-related complications, macrophage activation syndrome, death, or treatment escalation.
• Secondary outcomes included individual components of the primary endpoint, glucocorticoid use (discontinuation rates, dose reduction, and dosage at the last follow-up).

TAKEAWAY

• Patients receiving first-line biologic immune modulators achieved sustained event-free remission at higher rates than those receiving nonbiologic modulators at week 12 (89.7% vs 27.1%; P = .0059) and week 72 (74.5% vs 26.0%; P = .0081); event-free status was also higher with biologics at week 12 (89.7% vs 39.2%; P = .023) and week 72 (83.3% vs 40.5%; P = .029).
• Compared to MTX, biologic treatments were associated with higher event-free survival (odds ratio [OR], 2.99; P = .048), sustained event-free remission at week 72 (OR, 4.85; P = .006), and event-free status at week 12 (OR, 4.18; P = .017) and week 72 (OR, 3.82; P = .019).
• Biologics also showed advantages over CNI with higher sustained event-free remission (OR, 0.15; P = .028) and event-free status (OR, 0.11; P = .003) over the entire follow-up period.
• At week 72, biologics showed higher sustained event-free remission than all three comparators: MTX (OR, 0.12; P = .002), CNI (OR, 0.11; P = .001), and JAK inhibitors (OR, 0.14; P = .008). Glucocorticoid discontinuation was also more frequent in the biologic group than in the MTX (OR, 0.18; P = .015) and CNI (OR, 0.15; P = .005) groups.

IN PRACTICE

“These results suggest that a ‘top-down’ approach using biologics may improve clinical outcomes and reduce the long-term burden of steroid use in [adult-onset Still disease], though prospective validation is warranted given the observational nature of this study,” the authors of the study wrote.

SOURCE

The study was led by Ruru Guo, PhD, and Xuesong Liu, PhD, Renji Hospital, Shanghai Jiao Tong University School of Medicine in Shanghai, China. It was published online on July 20, 2026, in Arthritis Research & Therapy.

LIMITATIONS

The retrospective design in this rare and heterogeneous disease limited patient classification and covariate assessment. Glucocorticoid dose was adjusted for in regression models but not included in the propensity score, leaving the potential residual confounding from differential glucocorticoid exposure. Variations between centers, unknown factors, and the use of past safety data also limited the ability to draw cause-and-effect conclusions and apply the findings broadly.

DISCLOSURES

Fundamental Research Funds for the Central Universities provided support for this work through a grant to an author. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.