Clinical experience with the interleukin-1β blocker canakinumab in patients with chronic tophaceous gout: abolishment of arthritis and prevention of exacerbations when allopurinol is used

Елисеев, М. С.; Желябина, О. В.; Мукагова, М. В.; Насонов, Е. Л.

doi:10.14412/1996-7012-2015-2-16-22

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…При подагре он назначается исключительно для купирования приступа артрита, резистентного к любой другой противовоспалительной терапии, или в случае невозможности ее проведения. Однако стойкий противовоспалительный эффект препарата, который оказывает более мощное терапевтическое воздействие, чем колхицин и ГК, позволяет инициировать уратснижающую терапию и проводить титрование дозы аллопуринола с минимальным риском развития приступов артрита [14,[49][50][51].…”

Section: канакинумабunclassified

Prevention of arthritis attacks in the use of urate-lowering therapy in patients with gout

Чикина¹

2019

Naučno-praktičeskaâ revmatologiâ

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During the first months after initiation of urate-lowering therapy in patients with gout, the risk of exacerbating arthritis substantially increases, frequently causing them to refuse this treatment. The main way to avoid this risk is the preventive administration of colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids. This prevention of arthritis attacks is stipulated in the latest versions of many national and international guidelines; nevertheless, this tactic is rarely used in practice. The review presents the most significant studies on this problem.

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Section: канакинумабunclassified

Prevention of arthritis attacks in the use of urate-lowering therapy in patients with gout

Чикина¹

2019

Naučno-praktičeskaâ revmatologiâ

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“…Как и в отечественных рекомендациях, применение канакинумаба регламентируется наличием абсолютных противопоказаний к применению и/или неэффективностью НПВП и колхицина для профилактики приступов артрита в первые месяцы УСТ. Эффективность подобной терапии была показана в нескольких посмаркетинговых исследованиях [31,32].…”

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ACR management guidelines for the treatment of gout: What’s new and what’s controversial

Елисеев¹

2021

Naučno-praktičeskaâ revmatologiâ

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The community of many national and international recommendations dedicated to the treatment of a specific disease, including gout, is fully justified, since it allows taking into account, for example, regional, ethnic characteristics of the manifestations of the disease, which can be important when choosing a therapy. However, this is often associated with dissonance regarding the solution of key issues facing the practitioner. The publication in 2020 of the updated American College of Rheumatology (ACR) guidelines for the management of gout revealed controversy with some of the previous version’s postulates, as well as with other similar work, for example, with the guidelines published in the same year and the French Association of Rheumatology. Among the controversial provisions of the new version of the ACR recommendations are the unified target level of uric acid for all patients, indications for drug therapy, the choice of a drug in patients with reduced renal function, prevention of arthritis attacks when starting uratelowering therapy. This article discusses these and other controversial issues in gout therapy based on an analysis of the latest ACR guidelines.

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“…Способность предотвращать приступы артрита при инициации уратснижающей терапии наиболее изучена для колхицина [9,12,13], хотя есть немногочисленные данные о не меньшей эффективности НПВП [14,15] и ГК [11]. В исследованиях III фазы и в последующих постмаркетинговых испытаниях было показано, что подкожные инъекции ингибитора интерлейкина 1 канакинумаба при длительном наблюдении могут уменьшить вероятность приступа подагры [16,17]. Все перечисленные группы препаратов статистически значимо снижают частоту приступов артрита, однако их выбор и возможность длительной терапии с учетом противопоказаний к назначению (сердечно-сосудистые заболевания, нарушение функции почек и углеводного обмена и т.…”

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Comparison of the efficacy and safety of various anti-inflammatory drugs in urate-lowering therapy initiation in patients with gout (preliminary data)

Чикина¹,

Елисеев²,

Желябина³

2021

Sovremennaâ revmatologiâ

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Non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and glucocorticoids (GC) are used to prevent arthritis attacks in gout, but data on their comparative effectiveness is lacking.Objective: to compare the efficacy and safety of various anti-inflammatory drugs at the start of treatment in patients with gout.Patients and methods. Of the 108 patients with gout, observed in the V.A. Nasonova Research Institute of Rheumatology, 97 (94%), mostly men, entered a single-center prospective study. The observation period was at least 24 weeks, patients received combined urate-lowering and prophylactic anti-inflammatory therapy unintermittingly. The control group included 12 patients in whom anti-inflammatory drugs were contraindicated. At the start of urate-lowering therapy, allopurinol 100 mg per day was prescribed, followed by dose titration until the target uric acid (UA) level of < 360 μmol/L level was reached, in patients with severe tophus gout it was < 300 μmol/L. The maximum dose of allopurinol was 900 mg per day; in patients with reduced glomerular filtration rate (<60 ml/min/1.73m2 ) – 300 mg per day. For the prevention of arthritis attacks, the drug of choice was colchicine 0.5 mg per day, when contraindicated and/or poorly tolerated, NSAIDs were prescribed in the minimum effective dose. If there were any NSAIDs use restriction or intolerance – prednisone 7.5 mg per day was administered. The effectiveness of anti-inflammatory therapy (NSAIDs, colchicine or GC) was evaluated after 3 and 6 months which included analysis of the frequency of exacerbations and the duration of arthritis attacks, the intensity of pain according to the visual analogue scale (VAS) during a gout attack.Results and discussion. Of 97 patients with gout, 85 (88%) received anti-inflammatory therapy: NSAIDs – 16 (19%), colchicine – 60 (71%), GC – 9 (10%). In 65% of patients who were administered anti-inflammatory therapy, there were no recurrence of arthritis, whereas in 12 patients of the control group who did not receive this treatment, recurrence of arthritis was absent only in 25% of cases (p=0.008). After 3 and 6 months of follow-up, the duration of gout attacks and the intensity of joint pain according to the VAS for recurrent arthritis were significantly less (p< 0.05 in both cases) in the treatment group (with any anti-inflammatory drug) than without treatment. Arthritis attacks were more likely to be absent when taking NSAIDs than when using colchicine and GC both after 3 (63%) and 6 (81%) months (p< 0.05 in both cases). After 3 months of observation, the intensity of pain according to the VAS during the development of a gout attack was less for NSAIDs therapy than for colchicine and GC (p< 0.05 in both cases), and after 6 months there was no difference between NSAIDs, colchicine and GC. Within first 3 months, there was no difference in the duration of arthritis attacks among anti-inflammatory drugs, whereas after 6 months duration of attacks was the smallest for NSAID therapy (p< 0.05). Adverse reactions occurred only in NSAID and colchicine therapy in 2 and 5 patients, respectively. The patient's refusal to continue therapy without cause occurred in 13 (15%) cases, more often when taking colchicine.Conclusion. The proposed algorithm of anti-inflammatory drugs prescription for prevention of arthritis recurrence can reduce the risk of gout attacks development with good tolerance of the therapy. At the same time, better control of the frequency and duration of arthritis attacks, as well as the intensity of pain according to the VAS, is observed with the use of NSAIDs than with the use of colchicine and GC.

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Clinical experience with the interleukin-1β blocker canakinumab in patients with chronic tophaceous gout: abolishment of arthritis and prevention of exacerbations when allopurinol is used

Abstract: Ингибитор итерлейкина (ИЛ)

Cited by 10 publications

References 16 publications

Prevention of arthritis attacks in the use of urate-lowering therapy in patients with gout

Prevention of arthritis attacks in the use of urate-lowering therapy in patients with gout

ACR management guidelines for the treatment of gout: What’s new and what’s controversial

Comparison of the efficacy and safety of various anti-inflammatory drugs in urate-lowering therapy initiation in patients with gout (preliminary data)

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