Adult-onset Still Disease: When Initial Biologic Therapy Fails to Meet Targets

This protocol applies to patients with adult-onset Still disease (AOSD) whose initial biologic therapy has not achieved the defined response milestones. A structured next-line approach is indicated once those early targets are not met.

Prior Line — Failure Condition

The preceding protocol initiated an IL-1 inhibitor or an IL-6 inhibitor. Expected early milestones include resolution of fever and a substantial reduction in CRP by day 7, and further disease control benchmarks at week 4 — including absence of fever, meaningful joint count improvement, and normalisation of CRP. Failure to reach either of these targets triggers escalation to this protocol.

Next-Line Approach — Overview

When those targets are not reached, the approach involves a class switch between available biologic options, with continued glucocorticoid management. The complete sequencing, criteria, and accompanying measures are available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/ard-2024-225851

Failure to achieve one of these two targets should prompt IL-1 or IL-6 inhibitors rotation during which slow progressive GC tapering should be continued.

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