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ACTH vs betamethasone for the treatment of acute gout in hospitalized patients: A randomized, open label, comparative
Dimitrios Daoussis1, Panagiotis Kordas1,
1University Hospital of Patras, University of Patras Medical School, Division of Internal Medicine, Department of Rheumatology.
Insights
Adrenocorticotropic hormone (ACTH) is being studied as a treatment for acute gout in hospitalized patients. This research compares ACTH to betamethasone, focusing on efficacy and safety for gout management.
Area of Science:
- Rheumatology
- Endocrinology
Background:
- Hospitalized patients often have comorbidities and polypharmacy, limiting standard acute gout treatments like NSAIDs, colchicine, and steroids.
- Adrenocorticotropic hormone (ACTH) has a history of use in acute gout, showing good efficacy and safety.
Purpose of the Study:
- To compare the clinical efficacy of ACTH versus betamethasone for acute gout in hospitalized patients.
- To evaluate the safety profiles of ACTH and betamethasone.
- To investigate the impact of ACTH on immune responses and metabolic parameters, particularly glucose homeostasis.
Main Methods:
- A randomized, open-label comparative study involving 60 hospitalized patients with acute gout.
- Patients were randomized 1:1 to receive either ACTH or betamethasone.
- Clinical assessments (pain, global assessment, swelling, redness) were performed at multiple time points (baseline, 24, 48, 72 hours, 5 days).
- Serum and plasma samples were collected to analyze metabolic parameters, focusing on glucose homeostasis.
Main Results:
- The study is currently in the patient recruitment phase.
Conclusions:
- Verification of ACTH's efficacy and safety in this trial would strongly support its use for treating acute gout in hospital settings.
Background:
Hospitalized patients usually have significant comorbidities and receive multiple medications which leads to a high frequency of contraindications to standard treatment options for acute gout (NSAIDs, colchicine, steroids). Adrenocorticotropic hormone (ACTH) has long been used in acute gout, exhibiting significant clinical efficacy and an excellent safety profile.
Aim:
To assess 1) the clinical efficacy of ACTH in gout compared to betamethasone in hospitalized patients 2) the safety profile of ACTH vs betamethasone and 3) the effect of ACTH on immune responses and metabolic parameters.
Methods:
This is a randomized, open label comparative study directly comparing ACTH vs betamethasone for acute gout. We plan to recruit 60 hospitalized patients who will be randomly assigned to either the ACTH or the betamethasone group on a 1:1 basis. Patients will be clinically assessed at baseline and at 24, 48, 72h and 5days time points. (Intensity of pain, physician and patient global assessment, tenderness, swelling and redness). Serum and plasma samples will be collected at baseline and at the 24, 48, 72h time points from all study subjects. We will assess the effect of ACTH vs betamethasone on several metabolic parameters concentrating on glucose homeostasis.
Results:
The study is currently recruiting patients.
Conclusions:
If the efficacy and safety profile of ACTH is verified in this randomized controlled trial, the use of ACTH for the treatment of gout in the hospital setting will be strongly supported.
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