Anakinra's Efficacy is Variable in Refractory Gout: Report of Ten Cases

Chen, Kun; Fields, Theodore; Mancuso, Carol A.; Bass, Anne R.; Vasanth, Lisa

doi:10.1016/j.semarthrit.2010.03.001

Cited by 87 publications

(46 citation statements)

References 21 publications

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“…123,124 Rilonacept (IL-1 Trap) is a long-acting IL-1α/β fusion protein, currently approved for cryopyrin-associated periodic syndromes (CAPS), that has shown substantial efficacy in a phase 3 trial in acute gout. [125][126][127] Canakinumab is a fully human anti-IL-1β monoclonal antibody, also approved for treatment of CAPS, in phase 2/3 development in patients who are intolerant or resistant to colchicine and/ or NSAIDs.…”

Section: Agents In Development Acute Flarementioning

confidence: 99%

Managing Your Patient with Gout: A Review of Treatment Options

Doghramji¹

2011

Postgraduate Medicine

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Gout is an inflammatory arthritis that typically presents as acute onset, recurrent, monoarticular pain. In most patients, management of pain, risk assessment for future flares, and disability is not optimal and diagnostic and management approaches are applied inconsistently. Obtaining an accurate patient history, including comorbidities, concomitant medications, and familial history, is important for optimal results. Recognizing the acute flare in the patient at risk and establishing a definitive diagnosis of gout should be conducted promptly. Therapeutic options appropriate for treating the acute flare include colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids. After flare remission, prophylaxis with a flare prevention medication, such as colchicine, should be administered followed by initiation of urate-lowering therapy with allopurinol or febuxostat. Patient education, especially counseling on risk factors and contributors to hyperuricemia and gout, can improve the likelihood of successful therapy for this often suboptimally managed disease.

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Section: Agents In Development Acute Flarementioning

confidence: 99%

Managing Your Patient with Gout: A Review of Treatment Options

Doghramji¹

2011

Postgraduate Medicine

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“…There have been further reports of the use of anakinra in difficult to treat cases showing good efficacy, with most patients having a good response within 24 hours. [26][27][28][29][30][31] Anakinra has a good pharmacokinetic profile with a shorter duration of action, accumulation can occur in severe renal failure, 32 and this had been linked to an increased risk of infection in one case report. 31 The dose of a daily 100 mg has been used in studies looking at treatment of rheumatoid arthritis (usually between 50 and 150 mg), and it was well tolerated for up to 3 years.…”

Section: Interleukin-1 Inhibitorsmentioning

confidence: 99%

Feasibility randomised multicentre, double-blind, double-dummy controlled trial of anakinra, an interleukin-1 receptor antagonist versus intramuscular methylprednisolone for acute gout attacks in patients with chronic kidney disease (ASGARD): protocol study

et al. 2017

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IntroductionAcute gout occurs in people with chronic kidney disease, who are commonly older people with comorbidities such as hypertension, heart disease and diabetes. Potentially harmful treatments are administered to these vulnerable patients due to a lack of clear evidence. Newly available treatment that targets a key inflammatory pathway in acute gout attacks provides an opportunity to undertake the first-ever trial specifically looking treating people with kidney disease. This paper describes the protocol for a feasibility randomised controlled trial (RCT) comparing anakinra, a novel interleukin-1 antagonist versus steroids in people with chronic kidney disease (ASGARD).Methods and analysisASGARD is a two-parallel group double-blind, double-dummy multicentre RCT comparing anakinra 100 mg, an interleukin-1 antagonist, subcutaneous for 5 days against intramuscular methylprednisolone 120 mg. The primary objective is to assess the feasibility of the trial design and procedures for a definitive RCT. The specific aims are: (1) test recruitment and retention rates and willingness to be randomised; (2) test eligibility criteria; (3) collect and analyse outcome data to inform sample and power calculations for a trial of efficacy; (4) collect economic data to inform a future economic evaluation estimating costs of treatment and (5) assess capacity of the project to scale up to a national multicentre trial. We will also gather qualitative insights from participants. It aims to recruit 32 patients with a 1:1 randomisation. Information from this feasibility study will help design a definitive trial and provide general information in designing acute gout studies.Ethics and disseminationThe London-Central Ethics Committee approved the protocol. The results will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberEudraCT No. 2015-001787-19, NCT/Clinicalstrials.gov No. NCT02578394, pre-results, WHO Universal Trials Reference No. U1111-1175-1977. NIHR Grant PB-PG-0614–34090.

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“…35 Anakinra, a recombinant, synthetic IL-1 receptor antagonist that has been reported in case series to be effective in patients with acute gouty arthritis or acute urate crystal-induced arthritis and who are failing conventional therapy. 37,38 However, the data for anakinra are limited, the efficacy is variable, and relapse is common. 38 Further, the short half-life of the drug means that daily injections are required.…”

Section: Diagnosis and Clinical Featuresmentioning

confidence: 99%

“…37,38 However, the data for anakinra are limited, the efficacy is variable, and relapse is common. 38 Further, the short half-life of the drug means that daily injections are required.…”

Section: Diagnosis and Clinical Featuresmentioning

confidence: 99%

Gouty arthritis: Understanding the disease state and management options in primary care

Sunkureddi

2011

Adv Therapy

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Acute gouty arthritis is an inflammatory response triggered by the release of monosodium urate crystal deposits into the joint space. The disease is associated with debilitating clinical symptoms and functional impairments as well as adverse economic and quality-of-life burdens. Because gouty arthritis is typically diagnosed and managed in the primary care setting, clinicians require a thorough knowledge of the presenting clinical features, risk factors, differential diagnoses, and treatment options for appropriate management. Although generally effective, the use of currently available therapies to control gouty arthritis is challenging because many medications used to treat comorbidities can exacerbate gouty arthritis and because current agents are associated with a number of adverse events, contraindications, or both. Based on an understanding of the underlying inflammatory pathogenesis of gouty arthritis, several new agents are being developed that may provide improved efficacy.

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Anakinra's Efficacy is Variable in Refractory Gout: Report of Ten Cases

Cited by 87 publications

References 21 publications

Managing Your Patient with Gout: A Review of Treatment Options

Managing Your Patient with Gout: A Review of Treatment Options

Feasibility randomised multicentre, double-blind, double-dummy controlled trial of anakinra, an interleukin-1 receptor antagonist versus intramuscular methylprednisolone for acute gout attacks in patients with chronic kidney disease (ASGARD): protocol study

Gouty arthritis: Understanding the disease state and management options in primary care

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