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?
1 Answer
Mednet MemberInvited Expert
Rheumatology · University of Nevada - Las Vegas
Answered on
Emapalumab is an appropriate escalation in the described circumstance. I have no experience, and there is little published data as of yet with MAS825, but I would position this as an option to pursue before using etoposide. While there may be an indication of confounding, etoposide use nonetheless h...
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