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.
New England Journal of Medicine 355(6):p 581-592, August 10, 2006.

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 In 11 patients, anakinra was withdrawn at three months until a flare occurred.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.

Copyright © 2006 Massachusetts Medical Society. All rights reserved.
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