Issue: April 2021
Disclosures: The researchers report funding from Swedish Orphan Biovitrum AB. Saag reports grants and consulting fees from Horizon, Sobi and Amgen, as well as personal fees from Daiichi Sankyo and Gilead Sciences. Please see the study for all other authors’ relevant financial disclosures.
March 08, 2021
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Anakinra comparable to triamcinolone for reducing gout flare pain

Issue: April 2021
Disclosures: The researchers report funding from Swedish Orphan Biovitrum AB. Saag reports grants and consulting fees from Horizon, Sobi and Amgen, as well as personal fees from Daiichi Sankyo and Gilead Sciences. Please see the study for all other authors’ relevant financial disclosures.
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Although anakinra is not superior to triamcinolone in affecting gout pain intensity over 24 to 72 hours, it is comparable in pain reduction and even favored in most secondary outcomes, according to data published in Arthritis & Rheumatology.

“Anti-inflammatory drugs used for treatment of gout flares include NSAIDs, colchicine and glucocorticoids,” Kenneth G. Saag, MD, of the University of Alabama at Birmingham, and colleagues wrote.

Although anakinra is not superior to triamcinolone in changing patient reported gout pain intensity, it is comparable in pain reduction and even favored in most secondary outcomes, according to data.
Data were derived from Saag KG, et al. Arthritis Rheumatol. 2021;doi:10.1002/art.41699.

“However, many patients with gout have underlying comorbidities, including hypertension, chronic kidney disease, heart disease, gastroesophageal disease and diabetes that render them unsuitable for one or more of these treatments,” they added. “Thus, there is an unmet need for effective gout flare treatment for patients who have contraindications to, do not tolerate or are refractory to existing therapies.”

To analyze the efficacy and safety of the interleukin-1 receptor antagonist anakinra (Kineret, Sobi), compared with the corticosteroid triamcinolone in treating gout flares, Saag and colleagues conducted AnaGO, a multicenter, randomized, double‐blind, active-control study. A total of 165 adults with confirmed gout and at least one self-reported flare within the past year were randomly assigned to receive either anakinra — 100 mg or 200 mg per day for 5 days — or a single 40 mg injection of triamcinolone. The anakinra group included 110 participants, while 55 were treated with triamcinolone.

Kenneth G. Saag

The primary endpoint was the change in patient-reported pain intensity from baseline to 24 to 72 hours in the most affected joint, based on the visual analogue scale. Secondary outcomes included safety, immunogenicity and patient’s and physician’s global response assessments.

According to the researchers, there were a total of 301 flares reported, including 214 in the anakinra group and 87 among those treated with triamcinolone. Both treatments provided clinically meaningful reductions in patient-reported pain intensity during the first and subsequent flares. During the first flare, the mean pain intensity decline from baseline to 24 to 72 hours was –41.2 for anakinra and –39.4 for triamcinolone (P = .688). However, most secondary endpoints favored anakinra. There were no unexpected safety findings. In addition, anti‐drug antibodies were not associated with adverse events or altered pain reduction.

“This was the first large randomized clinical trial of anakinra,” Saag told Healio Rheumatology. “It looks like it works as well as steroids, or maybe even slightly better on some secondary outcomes. We need options for those who can’t use usual gout treatment.”