Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions

  title={Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions},
  author={Naomi Schlesinger and Rieke E Alten and Thomas Bardin and H. Ralph Schumacher and Mark Bloch and Alberto Gimona and Gerhard Dr. Krammer and Valda Murphy and Dominik Richard and Alexander So},
  journal={Annals of the Rheumatic Diseases},
  pages={1839 - 1848}
Objectives Gouty arthritis patients for whom non-steroidal anti-inflammatory drugs and colchicine are inappropriate have limited treatment options. Canakinumab, an anti-interleukin-1β monoclonal antibody, may be an option for such patients. The authors assessed the efficacy/safety of one dose of canakinumab 150 mg (n=230) or triamcinolone acetonide (TA) 40 mg (n=226) at baseline and upon a new flare in frequently flaring patients contraindicated for, intolerant of, or unresponsive to non… 
Canakinumab for the Patient With Difficult-to-Treat Gouty Arthritis: Review of the Clinical Evidence.
  • T. Bardin
  • Medicine
    Joint, bone, spine : revue du rhumatisme
  • 2015
Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial.
Efficacy of anakinra was shown to be non-inferior to treatment as usual for the treatment of acute gout flares, suggesting that anakinRA is an effective treatment alternative for acute g out flares.
Canakinumab: A Guide to Its Use in Acute Gouty Arthritis Flares
On-demand treatment with subcutaneous canakinumab 150 mg significantly relieved the pain and inflammation of a new gout flare, and reduced the risk of new flares in patients with acute gouty arthritis flares in whom standard treatment with non-steroidal anti-inflammatories and/or colchicine was inappropriate.
The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors.
GC, NSAID, low-dose colchicine, and canakinumab all effectively treat acute gout and there was insufficient evidence to rank them.
Canakinumab in gout
  • N. Schlesinger
  • Medicine, Biology
    Expert opinion on biological therapy
  • 2012
Canakinumab has been found to be superior to triamcinolone acetonide in acute gout and to colchicine in gout attack prophylaxis in reducing pain and risk of new gout attacks.
A Beacon in the Dark: Canakinumab. A New Therapeutic Perspective in Chronic Tophaceous Gout
Canakinumab appeared to be a viable, safe, and effective alternative to conventional therapies in this patient with gout who had limited therapeutic options, and a gradual, rapid, and significant reduction in pain.
Feasibility randomised multicentre, double-blind, double-dummy controlled trial of anakinra, an interleukin-1 receptor antagonist versus intramuscular methylprednisolone for acute gout attacks in patients with chronic kidney disease (ASGARD): protocol study
The protocol for a feasibility randomised controlled trial comparing anakinra, a novel interleukin-1 antagonist versus steroids in people with chronic kidney disease (ASGARD) is described, to assess the feasibility of the trial design and procedures for a definitive RCT.
Difficult-to-treat gout flares: eligibility for interleukin-1 inhibition in private practice is uncommon according to current EMA approval.
Despite significant numbers of patients without any SoC anti-inflammatory therapeutic options for gout flares, eligibility for IL-1 inhibition therapy according to current European approval is rare.
Effect of canakinumab on clinical and biochemical parameters in acute gouty arthritis: a meta-analysis
This meta-analysis shows the beneficial effect of canakinumab over triamcinolone by reducing VAS score, serum hsCRP, serum amyloid A, and improvement in global assessments in acute gouty arthritis.


Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study.
It is indicated that canakinumab 150 mg provides rapid and sustained pain relief in patients with acute gouty arthritis, and significantly reduces the risk of recurrent flares compared with triamcinolone acetonide.
Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: results of a double-blind, randomised study
Single canakinumab doses ≥50 mg or four 4-weekly doses provided superior prophylaxis against flares compared with daily colchicine 0.5 mg at 16 weeks.
The interleukin 1 inhibitor rilonacept in treatment of chronic gouty arthritis: results of a placebo-controlled, monosequence crossover, non-randomised, single-blind pilot study
It is demonstrated that rilonacept is generally well tolerated and may offer therapeutic benefit in reducing pain in patients with chronic refractory gouty arthritis, supporting the need for larger, randomised, controlled studies of IL1 antagonism such as with rilonACEpt for this clinical indication.
High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study.
Low-dose colchicine yielded both maximum plasma concentration and early gout flare efficacy comparable with that of high-dose Colchicines, with a safety profile indistinguishable from that of placebo.
Lumiracoxib 400 mg once daily is comparable to indomethacin 50 mg three times daily for the treatment of acute flares of gout.
Lumiracoxib is as effective as indomethacin for treatment of acute gout and may have a better safety and tolerability profile.
Efficacy and safety of the human anti-IL-1beta monoclonal antibody canakinumab in rheumatoid arthritis: results of a 12-week, phase II, dose-finding study
The addition of canakinumab 150 mg SC q4wk improves therapeutic responses among patients who have active RA despite stable treatment with methotrexate, and is associated with significantly more favorable responses at week 12 with respect to secondary endpoints.
Use of canakinumab in the cryopyrin-associated periodic syndrome.
Treatment with subcutaneous canakinumab once every 8 weeks was associated with a rapid remission of symptoms in most patients with CAPS and evaluated therapeutic responses using disease-activity scores and analysis of levels of C-reactive protein (CRP) and serum amyloid A protein (SAA).
Efficacy and safety profile of treatment with etoricoxib 120 mg once daily compared with indomethacin 50 mg three times daily in acute gout: a randomized controlled trial.
Etoricoxib was comparable in efficacy to indomethacin at a dosage of 50 mg 3 times daily, and it was generally safe and well tolerated.