26rhk029 10.3205/26rhk029 urn:nbn:de:0183-26rhk0293 Meeting Abstract Opitz Opitz Linda L

University of Leipzig, Hospital for Children and Adolescents, Department of Pediatric Immunology, Rheumatology and Infectiology, Leipzig, Deutschland

author Dunst Dunst Franziska F

University of Leipzig, Hospital for Children and Adolescents, Department of Pediatric Immunology, Rheumatology and Infectiology, Leipzig, Deutschland

author Klemann Klemann Christian C

University of Leipzig, Hospital for Children and Adolescents, Department of Pediatric Immunology, Rheumatology and Infectiology, Leipzig, Deutschland

author German Medical Science GMS Publishing House

Düsseldorf

610 20260909 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0656 029 Deutsche Gesellschaft für Rheumatologie Deutsche Gesellschaft für Orthopädische Rheumatologie Gesellschaft für Kinder- und Jugendrheumatologie 54. Kongress der Deutschen Gesellschaft für Rheumatologie und Klinische Immunologie (DGRh), 36. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR), 40. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh) Deutscher Rheumatologiekongress 2026 Experimentelle & Translationale Rheumatologie Leipzig 20260909 20260912 ET.01 TextIntroduction: Dual targeted therapy (DTT) may represent a therapeutic option in refractory Still’s disease; however, structured evidence remains limited.Methods: We report two pediatric cases and conducted a systematic review of published reports describing the concurrent use of more than one biologic and/or targeted synthetic disease modifying antirheumatic drug in Still’s disease. Pediatric-onset and adult-onset Still’s disease were analyzed as predefined subgroups.Results: In addition to our two original DTT cases, we identified 23 further patients with refractory Still’s disease treated with DTT, yielding a total of 25 cases, including 16 pediatric-onset and 9 adult-onset cases, with a mean of 4.3 prior treatment lines. Clinical improvement was reported in 17/25 patients, with remission documented in 10/25. Macrophage activation syndrome (MAS) was a frequent complication (9/25) but appeared less frequent after DTT initiation. In all patients with available paired data, markers of systemic inflammation declined markedly. Steroid-free status at last follow-up was achieved more frequently in pediatric-onset disease (9/16) than in adult-onset disease (1/9). No serious adverse events (SAEs) were observed in children, whereas SAEs occurred in adults (2/9).Conclusion: Dual targeted therapy appears effective in refractory Still’s disease, even after multiple treatment failures. The lower frequency of MAS after DTT initiation and the steroid-sparing effect highlight its clinical potential and support the rationale for simultaneous targeting of multiple inflammatory pathways. Fewer AEs and more favorable outcomes in pediatric-onset disease likely reflect differences in treatment strategies, comorbidity burden, and possibly underlying biology, underscoring the need for careful patient selection and prospective evaluation.Disclosures: The authors declare no conflicts of interest and received no specific funding for this work. Written informed consent for publication of the case reports was obtained. 0 0 0 0