To evaluate the timing of clinical inactive disease (CID) as defined by Wallace criteria, rates of treatment-free remission, biologic switching patterns, and macrophage activation syndrome (MAS) occurrence in children with childhood-onset Still's disease managed with early biologic therapy.
Approach:
Key Findings:
CID achieved in 11.1% (n=2) at 1 month, 66.7% (n=12) at 3 months, and 94.4% (n=17) at 6 months.
MAS developed early in 44.4% (n=8) of patients, with no recurrent episodes during follow-up.
66.7% (n=12) of patients achieved treatment-free remission at last follow-up.
Biologic switching occurred in 77.8% (n=14) of patients, mainly due to treatment burden.
Interpretation:
Early IL-1-targeted therapy was associated with rapid disease control, effective corticosteroid sparing, and high rates of treatment-free remission in childhood-onset Still's disease.
Limitations:
Small sample size of 18 patients may limit generalizability.
Potential referral bias to a tertiary care center may affect MAS frequency and observed treatment outcomes.
Conclusion:
Findings support early cytokine inhibition as a cornerstone of treat-to-target strategies and suggest a potential disease-modifying effect in Still's disease.
