Role of Interleukin‐1 Inhibitors in the Management of Gout
- 3 April 2013
- journal article
- research article
- Published by Wiley in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
- Vol. 33 (7), 744-753
- https://doi.org/10.1002/phar.1265
Abstract
Interleukin-1 (IL-1) inhibitors potentially have a role as antiinflammatory agents in refractory gout or for patients who are unable to tolerate conventional therapy, such as nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or glucocorticoids, for acute attacks. Additionally, IL-1 inhibitors may also help patients with polyarticular and tophaceous gout by making them less vulnerable to breakthrough attacks during initiation of chronic urate-lowering treatment, the mainstay of gout therapy. Because evidence highlights the role of proinflammatory cytokine IL-1 in the inflammation process during an acute gouty attack, IL-1 inhibitors are used to modulate the pathogenesis of a variety of autoinflammatory diseases, providing support for its potential role in the inflammatory process of gout. After NSAIDs, colchicine, and steroids, IL-1 inhibitors are beneficial as fourth-line therapy for acute gout attacks due to their high cost and limited clinical experience. The IL-1 inhibitors used in gout are anakinra, canakinumab, and rilonacept. Based on published evidence, anakinra has limited support in the form of anecdotal case reports to justify its use for treating gout. Canakinumab's toxic profile in clinical trials precludes its use in treating patients for gout, and rilonacept shows promise with a few well-designed studies to support its use in gout patients initiating urate-lowering treatment. When combined with current traditional therapies, these newer agents present clinicians and patients with more potential treatment options in the difficult-to-treat gout population.Keywords
This publication has 36 references indexed in Scilit:
- 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritisArthritis Care & Research, 2012
- Comparison of patient characteristics and gout-related health-care resource utilization and costs in patients with frequent versus infrequent gouty arthritis attacksRheumatology, 2012
- Evaluation of Newer Risk Markers for Coronary Heart Disease Risk ClassificationAnnals of Internal Medicine, 2012
- The Patient’s Experience of Gout: New Insights to Optimize ManagementCurrent Rheumatology Reports, 2011
- Gout therapeutics: new drugs for an old diseaseThe Lancet, 2011
- Interleukin‐1 antagonism in acute gout: Is targeting a single cytokine the answer?Arthritis & Rheumatism, 2010
- British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of GoutRheumatology, 2007
- A pilot study of IL-1 inhibition by anakinra in acute goutArthritis Research & Therapy, 2007
- EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)Annals Of The Rheumatic Diseases, 2006
- Preliminary criteria for the classification of the acute arthritis of primary goutArthritis & Rheumatism, 1977