Autoinflammatory & rare systemic diseases
Serum ferritin predicts response to tocilizumab in glucocorticoid-resistant adult-onset Still's disease: a prospective real-world cohort study
Authors' conclusion
TCZ is effective and steroid-sparing in GC-resistant AOSD. Baseline hyperferritinaemia (SF ≥2500 μg/L) is a potential biomarker for poorer outcomes, suggesting a need for tailored management.
Study context
- Population
- Patients with glucocorticoid (GC)-resistant adult-onset Still's disease (AOSD) who initiated intravenous tocilizumab (TCZ) (4–8 mg/kg every four weeks) between June 2021 and June 2024patients included (median age 35.5 years, 80% female)
- Participants
- 40 patients
- Outcome
- Clinical remission per 2024 EULAR/PReS criteria (clinically inactive disease [CID] lasting ≥6 months)
- Follow-up
- 12 months
Methodological detailsconsecutive eligible patients, real-world
- Consecutive eligible patients
- Real-world
Main finding
As reported in the abstract
Clinical remission at 12 months
55.0%
22/40
Observational data: associations, not effects.
Secondary outcomes
Remission, by baseline serum ferritin (SF) ≥ 2500 μg/L · 12 months
| Adjusted odds ratio for remission (95% CI) | P value | ||
|---|---|---|---|
| Baseline SF ≥ 2500 μg/LLower remission rates; independently associated | 0.19 (0.04–0.94) | P = 0.042 | |
| 0.050.21520Adjusted odds ratio for remission (log scale) |
| Outcome | β (95% CI) | P value |
|---|---|---|
| GC requirements, by baseline SF ≥ 2500 μg/L · 12 monthsHigher GC requirements; independently associated | 5.55 (1.16–9.94) | P = 0.015 |
CID · 6 months
- CID at 6 months
- 62.5% (25/40)
C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), SF and Pouchot scores
- Significant improvements in CRP, ESR, SF and Pouchot scores
- all p<0.001
Median daily prednisone dose
- Decrease
- 91%
- From
- 50.0 mg
- To
- 4.4 mg
- P
- P < 0.001
TCZ retention rate · 12 months
- 12-month TCZ retention rate
- 65.0%
Safety
Serious adverse events
- Macrophage activation syndrome (MAS)
- 7.5%
- Lymphoma
- 2.5%
Original publication
Serum ferritin predicts response to tocilizumab in glucocorticoid-resistant adult-onset Still's disease: a prospective real-world cohort study. Clin Exp Rheumatol. Published 22 October 2026. doi:10.
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