Clotilde Loustau1, Nicolas Rosine2, Marine Forien3, Sébastien Ottaviani3, Pierre-Antoine Juge2, Frédéric Lioté4, Thomas Bardin4, Pascal Richette4, Philippe Dieudé5, Christophe Richez6, Bernard Bannwarth1, Thierry Schaeverbeke6, Hang-Korng Ea4, Marie-Elise Truchetet7. 1. Service de rhumatologie, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. 2. Service de rhumatologie & Inserm UMR 1132 BIOSCAR, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France. 3. Faculté de médecine, university Paris-Diderot, Sorbonne-Paris-Cité, 75013 Paris, France. 4. Service de rhumatologie & Inserm UMR 1132 BIOSCAR, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; Faculté de médecine, university Paris-Diderot, Sorbonne-Paris-Cité, 75013 Paris, France. 5. Faculté de médecine, university Paris-Diderot, Sorbonne-Paris-Cité, 75013 Paris, France; Service de rhumatologie, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 78018 Paris, France. 6. Service de rhumatologie, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Immunoconcept, CNRS UMR 5164, Bordeaux University, Bordeaux 33076, France. 7. Service de rhumatologie, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Immunoconcept, CNRS UMR 5164, Bordeaux University, Bordeaux 33076, France. Electronic address: marie-elise.truchetet@chu-bordeaux.fr.
Abstract
OBJECTIVES: Interleukin (IL)-1β blocking is effective for the treatment of gout flares and is recommended in patients with contraindications to the standard of care, such as stage 4-5 chronic kidney disease (CKD) patients. However, efficacy and safety data regarding these agents are lacking in this population. We aimed to investigate the efficacy and safety of anakinra for the treatment of gout flares in patients with stage 4-5 CKD or renal transplantation. METHODS: This retrospective study encompassing 3 academic centres included consecutive patients with stage 4-5 CKD or kidney transplantation who received anakinra for the treatment of acute gouty arthritis and completed at least one follow-up visit. Efficacy, occurrence of infection, and renal function variations were recorded. RESULTS: Of the 31 included patients (24 men, mean age 72±11 years), 25 were non-transplant subjects with stage 4-5 CKD (mean estimated glomerular filtration rate, MDRD formula (eGFR) 22.7±6.5mL/min/1.73m2), and six had undergone kidney transplantation (mean eGFR 41.5±22.8mL/min/1.73m2). Median gout duration was 3.5 years, and the mean serum urate (SUA) level was 8.7mg/dL. Twenty-one (68%) patients had tophi, and 21 had gout arthropathy. Anakinra was efficacious in all patients (final VAS 10 and CRP level 10mg/L). Ten patients (32%) were anakinra dependent (i.e., required prolonged treatment with anakinra). A serious infection was recorded in only one patient, occurring 3 months after starting anakinra. No significant variation in renal function was observed. CONCLUSION: Anakinra may be a safe therapeutic option for gout patients with advanced CKD. Further randomized controlled studies are required to confirm our results.
OBJECTIVES: Interleukin (IL)-1β blocking is effective for the treatment of gout flares and is recommended in patients with contraindications to the standard of care, such as stage 4-5 chronic kidney disease (CKD) patients. However, efficacy and safety data regarding these agents are lacking in this population. We aimed to investigate the efficacy and safety of anakinra for the treatment of gout flares in patients with stage 4-5 CKD or renal transplantation. METHODS: This retrospective study encompassing 3 academic centres included consecutive patients with stage 4-5 CKD or kidney transplantation who received anakinra for the treatment of acute gouty arthritis and completed at least one follow-up visit. Efficacy, occurrence of infection, and renal function variations were recorded. RESULTS: Of the 31 included patients (24 men, mean age 72±11 years), 25 were non-transplant subjects with stage 4-5 CKD (mean estimated glomerular filtration rate, MDRD formula (eGFR) 22.7±6.5mL/min/1.73m2), and six had undergone kidney transplantation (mean eGFR 41.5±22.8mL/min/1.73m2). Median gout duration was 3.5 years, and the mean serum urate (SUA) level was 8.7mg/dL. Twenty-one (68%) patients had tophi, and 21 had gout arthropathy. Anakinra was efficacious in all patients (final VAS 10 and CRP level 10mg/L). Ten patients (32%) were anakinra dependent (i.e., required prolonged treatment with anakinra). A serious infection was recorded in only one patient, occurring 3 months after starting anakinra. No significant variation in renal function was observed. CONCLUSION: Anakinra may be a safe therapeutic option for goutpatients with advanced CKD. Further randomized controlled studies are required to confirm our results.
Authors: Huai Leng Pisaniello; Mark C Fisher; Hamish Farquhar; Ana Beatriz Vargas-Santos; Catherine L Hill; Lisa K Stamp; Angelo L Gaffo Journal: Arthritis Res Ther Date: 2021-04-28 Impact factor: 5.156
Authors: Helen Healy; Andrew J Kassianos; Kurt T K Giuliani; Anca Grivei; Purba Nag; Xiangju Wang; Melissa Rist; Katrina Kildey; Becker Law; Monica S Ng; Ray Wilkinson; Jacobus Ungerer; Josephine M Forbes Journal: Cell Death Dis Date: 2022-08-27 Impact factor: 9.685