Anakinra shows promise in gout treatment

The IL-1 receptor antagonist anakinra – a drug for rheumatoid arthritis – demonstrated potential in treating gout, as it reduced gout pain and flares to similar degrees as triamcinolone, results of the ANAGO* study have shown.

“In gout, urate crystals deposited in and around joints trigger episodes of acute arthritis,” said the researchers. Despite evidence showing the potential of anakinra in reducing pain and signs of acute flares in this difficult-to-treat patient population, confirmatory studies are lacking, they noted.

“[The findings suggest that] anakinra may be an alternative for treating acute flares [in gout patients] for whom conventional therapy is ineffective or contraindicated,” said the researchers.

The cohort comprised 165 patients with acute gout (median age 55 years, 87 percent male, mean self-reported flares in the past year 4.5) who were unsuitable for NSAID and colchicine therapy due to contraindication, intolerance, or inefficacy. Participants were randomized 1:1:1 to receive SC anakinra 100 or 200 mg QD for 5 days, or IM triamcinolone 40 mg.

Pain reduction

From baseline to day 1–3, the pain intensity dropped with both anakinra and triamcinolone at similar rates (mean change, –41.2 [pooled anakinra results] vs –39.4; mean between-group difference, –1.8; p=0.69). The efficacy of the 100- and 200-mg anakinra doses were comparable in terms of pain reduction (–41.8 and –40.7, respectively). [EULAR 2020, abstract THU0409]

“[Most] of the secondary** efficacy endpoints were numerically in favour of anakinra, and in most instances also statistically significant, in comparison to triamcinolone … No unexpected safety findings were identified in any of the treatment groups,” said the researchers.

Flare drops

In the extension phase evaluating subsequent flares, a total of 300 flares (one flare [n=161], two [n=61], three [n=31], ≥4 flares [n=20]) were treated and evaluated. [EULAR 2020, abstract THU0439]

From baseline to day 1–3, mean change in pain intensity during the second flare was similar between the anakinra (pooled) and triamcinolone arms (–33.9 vs –31.1; mean difference, –2.8). These were also similar to the reductions during the first flare, noted the researchers.

Although 20 percent of patients developed anakinra antidrug antibodies (ADA; six percent with pre-existing ADA; 11 percent were treatment-induced), this did not compromise the study drug’s efficacy, noted the researchers. “[The] presence of ADA was also not associated with adverse events,” they added.

“[The results suggest that] both anakinra doses and triamcinolone provided a clinically meaningful reduction in patient-assessed pain intensity in both the first and subsequent flares [in patients with difficult-to-treat acute gouty arthritis],” said the researchers.