SAT0367 Low-Dose Anakinra is Effective for the Prophylaxis of Acute Episodes of Inflammation In Severe Tophaceous Gout. (23rd January 2014)

• Record Type: Journal Article
• Authors: Perez-Ruiz, F.; Herrero-Beites, A. M.; Alonso-Ruiz, A.; Atxotegi, J.; Lopez-Santamaría, M. R.; de Miguel, M.
• Is Part Of: Annals of the rheumatic diseases. Volume 72:Supplement 3(2013)
• Page Start: A707
• Page End: A708
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-eular.2092
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: anakinra has been used off-label for the treatment of severe episodes of acute inflammation (EAIs) in gout [1 ], only a small retrospective series of 3 patients reported as prophylaxis with intermittent schedule [2 ]. Objectives: to explore whether a low-dose prescription of anakinra would be useful in patients with severe gout and contraindication of other current treatments for prophylaxis of AEIs when starting urate-lowering therapy (ULT). Methods: patients with crystal proven arthritis, tophaceous gout, and severe, recurrent EAIs showing aformal contraindication for current treatments for prophylaxis and requiring repeated doses of parenteral corticosteroids were included in a cohort for follow-up. All patients were scheduled to start ULT and receive anakinra 100 mg sc once a week with additional 100 mg doses on demand during the first 3 months and only on demand dosing from month 3 to 6. AEIs were evaluated using the EULAR-ACR preliminary criteria for self-referred AEIs in gout [3 ] and expressed as events/patient-year observation. Clinical evaluation and anaylsis (hemogram, full biochemistry including urate, estimated GF -CKD_EPI - and high sensitivity CRP) were monitored at baseline and months 3 and 6. Results: nine patients were included in the protocol, but 1 of them was excluded from analysis as he was shown to suffer also from crystal-proven chronic pyrophosphate inflammatory arthritis [4 ]. Mean age was 58±16 years (39-79), time with gout 9±4 years (5-16), polyarticular 75%. CHF was present in 4/8, CKD 3-4 in 6/8, serious AEs to NSAIDs in 6/8 and diabetes or steroid-induced hyperglycemia in 6/8. Results are shown in Table . In the 0-3 period, only 2/8 required additional doses, and 4/8 while only on demand from mo 3-6. A patient had an episode of heart failure (4 th in a year) but was maintained on treatment without further complications to date. Conclusions: this small sized pilot study is, to our knowledge, the first to explore in pre-established doses the efficacy of low-dose anakinra for the prophylaxis of AEIs in patients with severe comorbidities and severe tophaceous gout. These encouraging results deserve further studies. References: So A, DeSmedt T, Revaz S, Tschopp J. A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther 2007;9:R28. Tran AP, Edelman J. Interleukin-1 inhibition by anakinra in refractory chronic tophaceous gout. Int J Rheum Dis 2011;14:e33-e37. Gaffo AL, Schumacher HR, Saag KG, Taylor WJ, Dinnella J, Outman R et al. Developing a provisional definition of a flare in patients with established gout. Arthritis Rheum 2012; 64: 1508-17. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis 2011. Disclosure of Interest: F. Perez-Ruiz Consultant for: Ardea, Savient, Menarini, Astra, Metabolex, Pfizer, Novartis, SOBI, Speakers bureau: Menarini, A. Herrero-Beites: None Declared, A. Alonso-Ruiz: None Declared, J. Atxotegi: None Declared, M. Lopez-Santamaría: None Declared, M. de Miguel: None Declared