Neonatal-onset multisystem inflammatory disease responsive to interleukin-1beta inhibition.
Authors:
Goldbach-Mansky, R Dailey, NJ Canna, SW Gelabert, A Jones, J Rubin, BI Kim, HJ Brewer, C Zalewski, C Wiggs, E Hill, S Turner, ML Karp, BI Aksentijevich, I Pucino, F Penzak, SR Haverkamp, MH Stein, L Adams, BS Moore, TL Fuhlbrigge, RC Shaham, B Jarvis, JN O'Neil, K Vehe, RK Beitz, LO Gardner, G Hannan, WP Warren, RW Horn, W Cole, JL Paul, SM Hawkins, PN Pham, TH Snyder, C Wesley, RA Hoffmann, SC Holland, SM Butman, JA Kastner, DL
Citation:
Goldbach-Mansky R, etal., N Engl J Med. 2006 Aug 10;355(6):581-92.
BACKGROUND: Neonatal-onset multisystem inflammatory disease is characterized by fever, urticarial rash, aseptic meningitis, deforming arthropathy, hearing loss, and mental retardation. Many patients have mutations in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene, encoding cryopyrin, a protein that regulates inflammation. METHODS: We selected 18 patients with neonatal-onset multisystem inflammatory disease (12 with identifiable CIAS1 mutations) to receive anakinra, an interleukin-1-receptor antagonist (1 to 2 mg per kilogram of body weight per day subcutaneously). In 11 patients, anakinra was withdrawn at three months until a flare occurred. The primary end points included changes in scores in a daily diary of symptoms, serum levels of amyloid A and C-reactive protein, and the erythrocyte sedimentation rate from baseline to month 3 and from month 3 until a disease flare. RESULTS: All 18 patients had a rapid response to anakinra, with disappearance of rash. Diary scores improved (P<0.001) and serum amyloid A (from a median of 174 mg to 8 mg per liter), C-reactive protein (from a median of 5.29 mg to 0.34 mg per deciliter), and the erythrocyte sedimentation rate decreased at month 3 (all P<0.001), and remained low at month 6. Magnetic resonance imaging showed improvement in cochlear and leptomeningeal lesions as compared with baseline. Withdrawal of anakinra uniformly resulted in relapse within days; retreatment led to rapid improvement. There were no drug-related serious adverse events. CONCLUSIONS: Daily injections of anakinra markedly improved clinical and laboratory manifestations in patients with neonatal-onset multisystem inflammatory disease, with or without CIAS1 mutations. (ClinicalTrials.gov number, NCT00069329 [ClinicalTrials.gov].).