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Interleukin-1 inhibitors for acute gout
Francisca Sivera1, Mihir D Wechalekar, Mariano Andrés
1Servicio de Reumatologia, Hospital de Elda, Ctra. Elda-Sax, PTDA. La Torreta, S/N, Elda (Alicante), Spain, 03600.
The Cochrane Database of Systematic Reviews
|September 2, 2014
Summary
Interleukin-1 inhibitors like canakinumab may offer better pain relief for acute gout flares than triamcinolone but carry a higher risk of adverse events. Rilonacept showed less pain relief than indomethacin.
Area of Science:
- Rheumatology
- Pharmacology
- Clinical Trials
Background:
- Acute gout flares cause significant pain and disability.
- Effective pain relief is crucial for managing acute gout.
- Traditional treatments include colchicine, NSAIDs, and glucocorticoids.
Purpose of the Study:
- To evaluate the benefits and harms of interleukin-1 (IL-1) inhibitors (anakinra, canakinumab, rilonacept) for acute gout flares.
- To compare IL-1 inhibitors against placebo or active treatments.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and controlled clinical trials (CCTs).
- Searched Cochrane Library, MEDLINE, EMBASE, and conference abstracts.
- Assessed risk of bias and used GRADE approach for evidence quality.
Main Results:
- Canakinumab (150 mg) showed probable superiority over triamcinolone acetonide (40 mg) in pain relief and swelling resolution at 72 hours, but with increased adverse events (61% vs 51%).
- Indomethacin may provide better pain relief than rilonacept (320 mg) at 24-72 hours, with similar adverse event rates.
- No data on participant-reported pain relief of 30% or greater for canakinumab; function and quality of life were not measured.
Conclusions:
- Canakinumab (150 mg) likely improves pain, swelling, and treatment response in acute gout flares compared to triamcinolone acetonide, but with a probable increase in adverse events.
- Rilonacept (320 mg) may offer less pain relief than indomethacin for acute gout, with comparable adverse event rates.
- No studies compared canakinumab with first-line gout therapies (NSAIDs, colchicine); cost-effectiveness data is lacking.
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