IL-1 beta inhibition reduces gout attack risk
medwireNews: Administration of canakinumab, an interleukin (IL)-1β inhibitor, every 3 months is associated with a significantly reduced risk for gout, without lowering serum uric acid (SUA) levels, shows a secondary exploratory analysis of the CANTOS trial.
“Because the benefits were profound and were seen with the lowest canakinumab dosage (50 mg every 3 months), our data provide proof of concept that low-dose IL-1β inhibition might prevent the incidence of gout attacks, particularly among patients in whom current therapies have failed,” say Daniel Solomon (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and co-researchers.
They used the CANTOS data to explore whether canakinumab (50, 150, or 300 mg every 3 months) reduces the risk for gout attacks, and whether that effect is modified by baseline SUA concentrations.
Over a median follow-up of 3.7 years, the researchers recorded gout attacks in 96 of 6717 participants in the canakinumab group and in 99 of 3344 participants in the placebo group, giving overall incidence rates of 0.38 and 0.80 attacks per 100 person–years, respectively.
And the post-hoc analysis showed that, compared with placebo, quarterly doses of canakinumab significantly reduced the risk for a first gout attack by 52%, irrespective of gout history and without changing participants’ SUA levels.
The researchers note that the reduction in incident gout risk with canakinumab versus placebo was present at all baseline SUA concentrations, even those considered normal, ranging from 60% at 404.5 µmol/L or lower to 55% at 535.4 µmol/L or higher.
The data suggest that canakinumab may prevent gout because of IL-1β blockade rather than any downstream effects on SUA, write the researchers in the Annals of Internal Medicine, and they describe this observation as having “considerable clinical relevance.”
The researchers also note that canakinumab has “the added benefit of reducing the risk for cardiovascular events,” and therefore suggest that “[t]his treatment, if it were available at a lower price, may be a useful therapeutic option in the future for certain groups of patients with refractory gout who are also at risk for cardiovascular events.”
By Catherine Booth
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