How would you approach escalation of therapy in an adult patient with refractory Still’s disease and associated MAS/HLH (ferritin >100,000, transaminitis, DIC) despite high-dose steroids, high-dose anakinra, tocilizumab, and ruxolitinib?  

Subsequently, emapalumab was initiated with a loading dose, followed by etoposide, which led to improvement in both symptoms and laboratory values.

Is there any clinical experience with MAS825, the bispecific anti–IL-1β and anti–IL-18 monoclonal antibody? Should this agent be considered before or after etoposide in refractory cases?