ArticleFrontiers in pharmacology2026
Association between canakinumab dose and long-term remission in Still's disease: insights from the AIDA network registry.
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Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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92 authors.
Antonio VitaleDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Valeria CaggianoDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Jessica SbalchieroDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Giuseppe LopalcoDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy.
Abdurrahman TufanGazi University Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Türkiye.
Gaafar RagabInternal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt.
Petros P SfikakisJoint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Athens, Greece.
Lorenzo DagnaFaculty of Medicine, Università Vita-Salute San Raffaele, Milan, Italy.
Ezgi Deniz BatuDivision of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Türkiye.
Seza OzenDivision of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Türkiye.
Fabrizio ContiDepartment of Internal Medicine and Medical Specialties, Rheumatology Unit, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Federica MaioliniAzienda Ospedaliera Universitaria Integrata of Verona, Internal Medicine, Immunology Unit, Verona, Italy.
Serena BugattiDepartment of Internal Medicine and Therapeutics, Università di Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy.
Micol FrassiRheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy.
Piero RuscittiDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Maria MorroneDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy.
Francesco La TorreDepartment of Pediatrics, Pediatric Rheumatology Center (F.L.T.), Giovanni XXIII Pediatric Hospital, University of Bari Aldo Moro, Bari, Italy.
Ibrahim Yahya CakirGazi University Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Türkiye.
Nergis AkayDepartment of Paediatrics, Division of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Faculty of Medicine, Istanbul, Türkiye.
Elif Kilic KonteDepartment of Paediatrics, Division of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Faculty of Medicine, Istanbul, Türkiye.
Katerina LaskariJoint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Athens, Greece.
Yelda BilginerDivision of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Türkiye.
Angelica GattamelataDepartment of Internal Medicine and Medical Specialties, Rheumatology Unit, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Jacopo CroceAzienda Ospedaliera Universitaria Integrata of Verona, Internal Medicine, Immunology Unit, Verona, Italy.
Ludovico De StefanoDepartment of Internal Medicine and Therapeutics, Università di Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy.
Giulia VoltarelRheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy.
Paola CiprianiDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Maria Cristina MaggioUniversity Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy.
Sulaiman M Al-MayoufDepartment of Pediatrics, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Lampros FotisDepartment of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Donato RiganteDepartment of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Jurgen SotaDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Elena VerrecchiaPeriodic Fever Research Center, Università Cattolica Sacro Cuore, Rome, Italy.
Giuliana GugginoDepartment of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Palermo, Italy.
Lidia La BarberaDepartment of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Palermo, Italy.
Matteo PigaRheumatology Unit, Department of Medical Sciences and Public Health, University and AOU of Cagliari, Cagliari, Italy.
Giacomo EmmiDepartment of Medical, Surgical and Health Sciences, University of Trieste, Italy, and Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy.
Romina GallizziPediatric Rheumatology Department of Health Sciences, Magna Graecia University, Catanzaro, Italy.
Giovanni ContiPediatric Nephrology and Rheumatology Unit, Azienda Ospedaliero Universitaria (AOU) G Martino, Messina, Italy.
Paolo SfrisoRheumatology Unit, Department of Medicine, University of Padua, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Padua, Italy.
Elena BartoloniRheumatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Roberto GiacomelliClinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Rome, Italy.
Patrizia BaronePediatric Rheumatology Unit, Department of Integrated Maternal-Child and Reproduction Activity, AOU "Policlinico-San Marco", Catania, Italy.
Alma Nunzia OlivieriDepartment of Woman, Child and of General and Specialized Surgery, University of Campania ``Luigi Vanvitelli'', Naples, Italy.
Annachiara AlemannoDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Alberto Lo GulloUnit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy.
Haner DireskeneliDivision of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Türkiye.
Fatma Alibaz-OnerDivision of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Türkiye.
Anastasios KaramanakosDepartment of Rheumatology, "Evangelismos" General Hospital, Athens, Greece.
Marcella PreteRheumatic and Systemic Autoimmune Diseases Unit, Department of Interdisciplinary Medicine (DIM), University of Bari Medical School, Bari, Italy.
Amr EdreesDivision of Rheumatology, University of Missouri, Kansas City, MO, United States.
Francesco GavioliDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Paola ParronchiDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Francesco CicciaDepartment of Precision Medicine, Rheumatology Section, University of Campania Luigi Vanvitelli, Naples, Italy.
Chiara CardamoneUOC of Internal Medicine, Rheumatology Outpatients Unit, Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.
José Hernández-RodríguezDepartment of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain.
Gülen HatemiDepartment of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
Cemal BesDepartment of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye.
Ibrahim A AlmaghlouthRheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Ángel Robles MarhuendaDepartment of Internal Medicine, Autoimmune Disease Unit, Hospital Universitario La Paz, Madrid, Spain.
Andrés Gonzáles-GarcíaSystemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
Carla GaggianoDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Amato De PaulisDepartment of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy.
Mehmet Engin TezcanCenter for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy.
Antonio Luca BrucatoDepartment of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy.
Eugen FeistDepartment of Rheumatology and Clinical Immunology, Helios Fachklinik Vogelsang-Gommern Klinik für Rheumatologie, Gommern, Germany.
Fernando Tornero-RomeroAutoimmune Diseases Unit, Department of Internal Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
Benoit SuzonDepartment of Internal Medicine, Martinique University Hospital, Fort-de-France, Martinique.
Benson OgunjimiAntwerp Center for Translational Immunology and Virology (ACTIV), Center for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
Maissa ThabetInternal Medicine Department, Farhat Hached University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.
Alessandro ConfortiOspedale San Paolo Di Civitavecchia, U.O. Medicina Generale, ASL Roma 4, Civitavecchia, Italy.
Valentina PucinoClinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Oksana BoyarchukDepartment of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
Tetiana KovalchukDepartment of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
Marcello GovoniRheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Ferrara, Italy.
Annamaria IagnoccoAcademic Rheumatology Center, Dipartimento Scienze Cliniche e Biologiche, Università Degli Studi Di Torino, Turin, Italy.
Maria Sole ChimentiRheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Abdelhfeez MoshrifRheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Emanuela Del GiudiceDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Rome, Italy.
Francesco CarubbiDepartment of Life, Health and Environmental Sciences, University of L'Aquila; Internal Medicine and Nephrology Division, Avezzano-Sulmona-L'Aquila Local Health Authority 1, San Salvatore Hospital, L'Aquila, Italy.
Şükran ErtenDepartment of Rheumatology, Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Türkiye.
Samar TharwatRheumatology and Immunology Unit (S.T.), Internal Medicine Department, Mansoura University, Mansoura, Egypt.
Mohamed Tharwat HegazyInternal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt.
Ewa Więsik-SzewczykDepartment of Internal Medicine, Pneumonology, Allergology, Clinical Immunology and Rare Diseases, Military Institute of Medicine, National Research Institute, Warsaw, Poland.
Jiram Torres-RuizDepartment of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Eduardo Martín-NaresDepartment of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Albert BalistreriAzienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy.
Claudia FabianiAzienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy.
Bruno FredianiDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Andrea Hinojosa-AzaolaDepartment of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Özgür KasapçopurDepartment of Paediatrics, Division of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Faculty of Medicine, Istanbul, Türkiye.
Luca CantariniDepartment of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objective: The primary aim of this study was to assess, in Still's disease, whether the employment of canakinumab at a strictly on-label dose may increase the likelihood of treatment discontinuation due to study-defined long-term remission (LTR), compared with patients receiving lower doses. Methods: Patients were drawn from the international Autoinflammatory Disease Alliance (AIDA) Network registry dedicated to Still's disease and stratified based on the starting canakinumab dose: the on-label group received either 300 mg every 4 weeks or 150 mg every 4 weeks (corresponding to 4 mg/kg), while the underdosed group received 150 mg every 4 weeks (corresponding to a dose not exceeding 3.5 mg/kg). Bayesian regression models were implemented to estimate the probability of achieving long-term remission with subsequent canakinumab withdrawal in the two groups, as well as the mean differences in probabilities and posterior probabilities indicating whether the on-label group was superior in achieving the endpoint. Results: In total, 131 patients (16.7%) were enrolled, 81 (61.8%) receiving the on-label posology and 50 (38.2%) the underdosed posology. The estimated marginal posterior probability of canakinumab discontinuation due to LTR was 19% (CrI 7.5%-34.6%) in the on-label group and 3.9% (CrI 0.7%-15.2%) in the underdosed group, yielding a mean difference of 15.1% (CrI 1.4%-31.4%) and a posterior probability of 98.4%. This difference remained credible, with posterior probabilities ranging from 97.9% to 99.6%, irrespective of disease course or age at disease onset. Conclusion: On-label canakinumab dosing appears to increase the likelihood of study-defined LTR with subsequent treatment discontinuation, compared with underdosed treatment strategies.
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arthritisautoinflammatory diseasesbiologic therapypersonalized medicineprecision medicine
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