Anakinra Safely, Effectively Manages Difficult-to-Treat Gouty Arthritis

Treatment with anakinra, an interleukin-1 (IL-1) inhibitor, was safe and effective for managing flares in difficult-to-treat patients with gout, according to a study published in Frontiers in Medicine.¹ Used in multiple complex scenarios, such as polyarticular gout, dialysis, active infections, and chronic kidney disease, the drug was also proven to be effective as a long-term treatment. However, concerns remain regarding certain safety aspects.

Sicylle Jeria-Navarro, MD

“Nonsteroidal anti-inflammatory drugs, corticosteroids, and colchicine are the first-line agents, although they are contraindicated in many patients,” lead investigator, Sicylle Jeria Navarro, MD, of the Rheumatology Department at the Hospital Universitari de la Santa Creu i Sant Pau in Barcelona, Spain, and colleagues, explained. “Blockade of IL-1 with anakinra can be an alternative.”

Information from patients with gout from a tertiary teaching referral center in Barcelona was extracted from medical records between January 2009 and December 2020. Reviewers performed a 2-stage screening process by title/abstract and full-text reading of 1519 citations. Ultimately, 28 articles met inclusion criteria and were used for data extraction and synthesis. Any experience in difficult-to-treat and complex clinical scenarios were described. Comorbidities included chronic kidney disease, transplantation, dyslipidemia, diabetes mellitus, hypertension, and cardiovascular disease.

The sample of 551 patients with gout identified and analyzed 648 flares. The mean age was 57.9 years and most (82.9%) of patients were male. Clinical presentation of gout was classified as 66.9% tophaceous and 47.5% polyarticular and more than half of patients had at least 1 associated comorbidity.

Ten patients treated with anakinra for gout flare were included in the case series, with a median age of 70.5 years and 90% were male. In total, 65 patients in the clinical complex scenarios portion presenting an active infection, 41 transplanted patients, and 14 in hemodialysis received anakinra. The drug did not affect response to prior antimicrobial therapy given before the first anakinra dose in any of these patients.

Anakinra effectively treated flares (93.9%, n = 598) and was successful as a long-term treatment option (91%) and well tolerated, with response to treatment reported as complete or partial within 1-3 days. Only 28 patients (5.1%) were non-responders.

In terms of safety, a total of 6.7% (n = 34) adverse events (AEs) were reported in the flare treatment group, most of which classified as mild or transient, which were more common in those receiving the drug long-term. The most common AEs were injection site reactions, reversible hematological disorders, and acute infections. In patients placed in the long-term treatment category, 7 infections were reported, including 2 staphylococcus aureus tophus infections, an S aureus lung abscess, an erysipelas infection of the leg, a Streptococcus B urinary tract infection, and arthritis of the knee due to S aureus.

The cross-sectional study design and using most of the data included from the case series limited results. Further, investigators were unable to compare studies due to the heterogeneity of flare, refractory gout, or clinical improvement definitions. Lastly, a systematic review or meta-analysis could not be performed.

“The use of anakinra for the treatment of acute gout flares seems to be an effective and safe alternative to the standard of care,” Jeria Navarro concluded. “High-quality control trials are needed for the standardization of the use of anakinra in gout patients, especially for refractory cases.”

References

^{Jeria-Navarro S, Gomez-Gomez A, Park HS, et al. Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature. Front Med (Lausanne). 2023;9:1089993. Published 2023 Jan 12. doi:10.3389/fmed.2022.1089993}