Neonatal-Onset Multisystem Inflammatory Disease Responsive to Interleukin-1(beta) Inhibition
- Goldbach-Mansky, Raphaela
- Dailey, Natalie J.
- Canna, Scott W.
- Gelabert, Ana
- Jones, Janet
- Rubin, Benjamin I.
- Kim, H. Jeffrey
- Brewer, Carmen
- Zalewski, Christopher
- Wiggs, Edythe
- Hill, Suvimol
- Turner, Maria L.
- Karp, Barbara I.
- Aksentijevich, Ivona
- Pucino, Frank
- Penzak, Scott R.
- Haverkamp, Margje H.
- Stein, Leonard
- Adams, Barbara S.
- Moore, Terry L.
- Fuhlbrigge, Robert C.
- Shaham, Bracha
- Jarvis, James N.
- O'Neil, Kathleen
- Vehe, Richard K.
- Beitz, Laurie O.
- Gardner, Gregory
- Hannan, William P.
- Warren, Robert W.
- Horn, William
- Cole, Joe L.
- Paul, Scott M.
- Hawkins, Philip N.
- Pham, Tuyet Hang
- Snyder, Christopher
- Wesley, Robert A.
- Hoffmann, Steven C.
- Holland, Steven M.
- Butman, John A.
- Kastner, Daniel L.
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 In 11 patients, anakinra was withdrawn at three months until a flare occurred.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.)
N Engl J Med 2006;355
581-92.