Lane, T;
Wechalekar, AD;
Gillmore, JD;
Hawkins, PN;
Lachmann, HJ;
(2017)
Safety and efficacy of empirical interleukin-1 inhibition using anakinra in AA amyloidosis of uncertain aetiology.
Amyloid
, 24
(3)
pp. 189-193.
10.1080/13506129.2017.1352503.
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Gillmore_amyloidosis of uncertain aetiology MAJOR REVISION FORMATTED 20Jun2017 CLEAN COPY.pdf - Accepted Version Download (137kB) | Preview |
Abstract
OBJECTIVE: AA amyloidosis is a serious complication of persistent inflammation, which, untreated will progress to renal failure and death. Effective suppression of the underlying inflammatory disease is the focus of treatment. However, in approximately 20% of cases the underlying condition remains uncertain, presenting a dilemma as to choice of treatment. METHODS: We conducted a retrospective study of a cohort of 11 patients diagnosed with AA amyloidosis of unknown aetiology, who had been empirically treated with anakinra. RESULTS: In anakinra-responders, median pre-treatment SAA was 74 (IQR 34-190) mg/L, and median on-treatment SAA was 6 (4-16) mg/L (p = .0047), with the response having been maintained for a median on-treatment follow-up of 1.8 (1-7.6) years. Six dialysis patients were treated effectively and safely with 100 mg anakinra three times weekly post-dialysis. Four patients remained well on daily anakinra post-renal transplant. Five anakinra-responders showed regression and three showed stabilization of amyloid load on serial SAP scintigraphy. CONCLUSIONS: This small cohort shows that even in potentially high risk cases with organ damage secondary to AA amyloidosis or in the presence of a renal graft, anakinra, when used appropriately and carefully monitored, has proved remarkably effective and well tolerated. Longer follow-up of this off-label use is required.
| Type: | Article |
|---|---|
| Title: | Safety and efficacy of empirical interleukin-1 inhibition using anakinra in AA amyloidosis of uncertain aetiology |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1080/13506129.2017.1352503 |
| Publisher version: | http://doi.org/10.1080/13506129.2017.1352503 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | AA amyloidosis, anakinra, dialysis, interleukin-1, renal transplant |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1567630 |
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