title: Role of interleukin-1 inhibitors in the management of gout.
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.
authors.affiliation: New York Presbyterian Hospital/Columbia Medical Center, College of Pharmacy and Health Sciences, St. John's University, Queens, New York 11439, USA. Trant1@stjohns.edu
authors.forename: Tran H
authors.initials: TH
authors.lastname: Tran
authors.forename: Jacqueline T
authors.initials: JT
authors.lastname: Pham
authors.forename: Hira
authors.initials: H
authors.lastname: Shafeeq
authors.forename: Kendra R
authors.initials: KR
authors.lastname: Manigault
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Arya
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D006073:Gout / Q000188:drug therapy* / Q000503:physiopathology; D006074:Gout Suppressants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D007375:Interleukin-1 / Q000037:antagonists & inhibitors* / Q000378:metabolism; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D006074:Gout Suppressants; D053590:Interleukin 1 Receptor Antagonist Protein; D007375:Interleukin-1; D011993:Recombinant Fusion Proteins; C541220:canakinumab; C531377:rilonacept
keywords: anakinra; canakinumab; gout; interleukin-1 inhibitors; interleukin-1 receptor antagonists; rilonacept