Biologics are more effective at treating adult-onset Still’s disease (AOSD) than are glucocorticoids or conventional disease-modifying antirheumatic drugs (DMARDs) Half of the patients treated with first-line biologic DMARDs achieved sustained event-free remission compared with 12% of patients in the conventional therapy group the odds of reaching sustained remission on biologics was more than seven times greater than on conventional therapy that the use of biological DMARDs as a first-line therapy in patients with adult-onset Still’s disease is clearly advantageous over first-line conventional synthetic DMARD therapy,” wrote senior author Stefan Vordenbäumen of the St Elisabeth-Hospital Meerbusch-Lank in Meerbusch Still’s disease is a rare inflammatory condition characterized by fevers, rash, and joint pain. The term was previously used to describe only adult patients, whereas a similar condition in children is still often referred to as systemic juvenile idiopathic arthritis many experts agree that these diseases are “a continuum of the same disease,” the authors wrote Biologics are increasingly used to treat AOSD, in line with 2024 recommendations by the European Alliance of Associations for Rheumatology and the Paediatric Rheumatology European Society these recommendations “rely heavily on efficacy data in children,” they explained as clinical studies of these drugs have failed to meet their primary endpoints in adult patients the authors aimed to determine how biologic DMARD therapy compared against conventional DMARD therapy in AOSD The analysis, published on March 28, 2025, in The Lancet Rheumatology Patients were treated across 16 secondary and tertiary rheumatology centers in Germany beginning in 2007 44 received biologic therapy; most of the patients (84%) started treatment with the interleukin-1 (IL-1) inhibitor anakinra five patients started on the IL-6 inhibitor tocilizumab and two patients started the IL-1 inhibitor canakinumab 9 of the 37 patients originally taking anakinra switched to canakinumab because of injection site reactions.) About three out of four patients in the biologic group were also concurrently taking glucocorticoids Of the 42 patients started on conventional synthetic DMARDs 12 patients received methotrexate with steroids and one patient received immunoglobulin therapy biologics were associated with a greater likelihood of achieving sustained which was the primary endpoint of the study (odds ratio More patients in the biologic group (32 of 44) had also stopped glucocorticoids at week 72 than those in the conventional therapy group (18 of 42) This finding “is particularly important given the well-documented adverse effects of long-term glucocorticoid use” Yi-Ming Chen, MD, PhD, of the Taichung Veterans General Hospital, Taichung, Taiwan, and Der-Yuan Chen, MD, PhD, of the China Medical University, Taichung, Taiwan, wrote in an accompanying editorial three patients in the conventional synthetic DMARD group died — two of macrophage activation syndrome and one of unknown causes There were no deaths in the biologic group a rheumatologist at Hospital for Special Surgery in New York City “It gives you real-world evidence” of the efficacy of biologics in AOSD which is difficult with a rare disease such as AOSD The high prevalence of IL-1 inhibitors in the study “limits conclusions about the comparative efficacy of different biologic DMARDs,” Yi-Ming Chen and Der-Yuan Chen wrote but comparing the efficacy of different biologic DMARDs in future studies on AOSD could be valuable “particularly given the emergence of biomarker-based approaches to treatment selection.” Additional studies evaluating the efficacy of calcineurin inhibitors in AOSD could also be useful or perhaps combining biologics and calcineurin inhibitor therapy could boost the percentage of patients reaching sustained remission Paired with further insights on the molecular landscape of Still’s disease the study’s findings “support the feasibility of a more personalized evidence-based approach to first-line biological DMARD therapy,” Yi-Ming Chen and Der-Yuan Chen noted driven by robust clinical evidence and advancing molecular insights could usher in a new era in the management of Still’s disease in which early biological DMARD therapy becomes the standard of care for appropriately selected patients.” Mehta is an advisory board member of Horizon Therapeutics and a consultant for BICMD and WebMD Yi-Ming Chen and Der-Yuan Chen had no disclosures Send comments and news tips to news@medscape.net This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page Please enable JS and disable any ad blocker Rescue workers are pictured at the site of train crash in Meerbusch west of Duesseldorf 2017 in this picture obtained from social media BERLIN - Several people were injured in a train crash on Tuesday near the German city of Duesseldorf Rail operator Deutsche Bahn said a passenger train of the regional provider National Express drove into a freight train from DB Cargo about 1830 GMT in the town of Meerbusch The Meerbusch fire department said up to 150 passengers were on the train and that 5 people suffered injuries A police spokesman earlier had told German broadcaster ARD that about 50 people had been injured in the train crash A German government spokesman said Chancellor Angela Merkel had been briefed on the situation Passenger train and freight train reported to have collided near station in the German town of Meerbusch The aftermath of train crash in Düsseldorf – videoGermany This article is more than 7 years oldUp to 50 injured in train crash near Düsseldorf – reportsThis article is more than 7 years oldPassenger train and freight train reported to have collided near station in the German town of Meerbusch Several people have been injured after a passenger train and a freight train collided near Düsseldorf, German police said. The incident occurred near a train station in the town of Meerbusch, the DPA news agency reported on Tuesday. Authorities said there were multiple injuries but did not immediately provide more specific information. Local media reported up to 50 had been injured. Emergency crews were on the scene and were helping to unload people from the passenger train. A photo tweeted by the Meerbusch fire department showed the passenger train partially derailed but still upright. Notifications can be managed in browser preferences. Local fire service tweets picture showing carriage damaged but upright and on the tracks I would like to be emailed about offers, events and updates from The Independent. Read our Privacy notice At least 40 people have been injured in a train crash close to the west German city of Dusseldorf after a passenger and freight train collided, police said. Authorities said the accident occurred near the train station in the town of Meerbusch. Initial reports gave the number injured as 50, a figure that was later revised down. The 41 injured include serious and minor injuries, although none are said to be life-threatening, according to the local fire department. Emergency crews were on the scene helping to unload people from the passenger train. A photo posted by the Meerbusch fire department showed the passenger train partially derailed but still upright. In a series of tweets the local fire service confirmed five people were injured with "up to 150 people" still stuck inside the train. A hanging cable was impeding the rescue efforts, the department said. The accident occurred on the line between Meerbusch-Osterath and Neuss, both suburbs in the west of Dusseldorf, at around 7.30pm local time (8.30pm GMT). Federal Police earlier said up to 50 were injured, while state-run German rail company Deutsche Bahn (DB) gave the figure as 20. "DB and the competent authorities as well as emergency services are on the spot to provide quick help for the victims and to clarify the situation," the company said in a statement. Join thought-provoking conversations, follow other Independent readers and see their replies