Effectiveness of Anakinra in Acute Gout: A Retrospective Review of Initial and Refractory Therapy

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To the Editor:
The American College of Rheumatology recommends nonsteroidal anti-inflammatory drugs, colchicine, or systemic corticosteroids as first line therapy for acute gout attacks.1 Patient-specific factors, such as renal dysfunction, potential drug interactions or inadequate response to first line therapies, may cause providers to seek alternative medication therapies. Interleukin-1 antagonism with anakinra is a potential treatment option in patients with these clinical scenarios. Anakinra is not Food and Drug Administration approved for treatment of acute gout attacks and there is currently limited evidence characterizing use of anakinra for this indication.
A noninterventional, retrospective, single-center chart review was conducted for all patients admitted to an academic medical center between November 2013 and October 2015. This study was approved by the Institutional Review Board with a waiver of informed consent. Adult patients were included if they had a medication order for anakinra, were admitted to an internal medicine service, and had an admission diagnosis of acute gout. Data are reported as medians [interquartile range (IQR)] or number (%).
Ten unique patients were identified during the study period. Baseline characteristics are provided in Table 1. Nine (90%) of patients had a primary admission diagnosis of acute gouty arthritis. Anakinra was prescribed for 4 doses (3–5) during a median hospital length of stay of 7 days (4–16 days). Eight patients (80%) received other gout therapies during their hospitalization with either colchicines (20%) or corticosteroids (80%). Only 3 patients (30%) had at least a 24 hours trial of first line inpatient gout therapy before anakinra initiation. Pain scores on day 1 of anakinra were 6.5 (3.8–8.8) and were not significantly changed at 5.5 (3.5–8) on discharge (P = 0.9).
Anakinra is most commonly prescribed for gout treatment at 100 mg daily for 3 days.2 Longer durations of therapy were prescribed in the majority of patients. No patient had an absolute contraindication to first line gout therapies; however, the majority of patients did not receive first line therapy while admitted to the hospital. The results seen in this review are consistent with a previous study.3
This study did not find a difference in subjective symptoms with anakinra usage in acute gout treatment. Previous literature predominantly examined patients refractory to or with contraindications to first line gout therapy. Several patients were trialed on anakinra as first line therapy in the absence of contraindications to first line therapy. Further, preferably prospective, studies should be conducted to further evaluate anakinra's role for gout therapy.
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