Anakinra ‘an additional option’ to treat flares in difficult-to-treat gout
medwireNews: Phase 2 study anaGO findings presented in a poster at the EULAR 2020 E-congress reveal that patients with difficult-to-treat gout who receive the interleukin-1 receptor antagonist anakinra report comparable levels of pain reduction to those given triamcinolone.
The study included 161 patients (median age 55 years, 87% male) with gout for whom conventional therapy was contraindicated or ineffective. Participants were randomly assigned to receive subcutaneous anakinra at a dose of 100 mg/day (n=56) or 200 mg/day (n=52) for 5 days or a single injection of triamcinolone 40 mg (n=53).
“Both doses of anakinra showed comparable efficacy in pain reduction,” reported Kenneth Saag, from the University of Alabama in Birmingham, USA, and team. The mean decrease in visual analog scale pain intensity scores from baseline to 24–72 hours post-treatment was 41.8 points with anakinra 100 mg/day and 40.7 points with the 200 mg/day dose.
The average decrease in pain intensity across both anakinra doses was 41.2 points, and this was similar to the 39.4-point reduction reported by the patients who received triamcinolone, giving a nonsignificant between-group difference of 1.8 percentage points.
The researchers noted that “[t]he majority of secondary efficacy endpoints favored anakinra.” Indeed, physician assessments of tenderness, swelling, and erythema at day 4 were all significantly improved in patients who received anakinra versus those given triamcinolone, as were the levels of C-reactive protein (CRP) and serum amyloid A.
By 8 days after treatment, anakinra-treated patients also had significantly higher scores on patient and physician assessments of global response, while maintaining significantly better scores in physician assessments of swelling and in the levels of both CRP and serum amyloid A.
However, at day 15 post-treatment, the only significant differences between the two groups were a better patient assessment of global response favoring the anakinra group and significantly better CRP levels in the triamcinolone group.
There were “[n]o unexpected safety findings,” the team reported, with neutropenia and headache the most common adverse events in patients who received anakinra and triamcinolone, respectively, each observed at a rate of 3.7%. Furthermore, Saag emphasized that the “[s]afety profile of anakinra was similar to that seen [in] studies in other indications and during post-marketing use.”
In light of the findings from the multicenter study, Saag concluded: “Anakinra was shown to be an additional option for use during acute gout flares.”
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