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Gout Attacks Are Reduced With an Interleukin-1β Inhibitor
The use of canakinumab, a monoclonal antibody targeting Interleukin-1β (IL-1β), leads to fewer gout attacks, according to results of a secondary exploratory analysis.
Previous research has shown that IL-1β inhibitors may compress the length of a gout attack. However, whether these inhibitors could prevent an episode of gout from occurring was previously unknown.
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For the analysis, the researchers analyzed data from patients enrolled in the Canakinumab Anti-inflammatory Thrombosis Outcomes Study who had high-sensitivity C-reactive protein levels of at least 19.1 nmol/L, regardless of aggressive management and care.
Patients were previously randomly assigned to receive 50 mg, 150 mg, or 300 mg canakinumab, or placebo, subcutaneously every 3 months.
Results showed that canakinumab had significantly reduced the rate of gout attacks at all baseline concentrations of serum uric acid. The hazard ratios [HRs] were 0.40 for patients with a level of 404.5 µmol/L or lower; 0.48 for patients with a level between 404.6 and 535.3 µmol/L; and 0.45 for patients with a level of 535.4 µmol/L or higher.
Patients who received placebo had higher incidence rates for gout attacks across all serum uric acid concentrations. Incident rates were 0.28 per 100 person-years for those with a level at 404.5 µmol/L or lower; 1.36 per 100 person-years for those with a level between 404.6 and 535.3 µmol/L; and 5.94 per 100 person-years for those with a level at 535.4 µmol/L or higher.
Serum urate levels remained the same over time for patients who received canakinumab, which suggested it can act as an independent mechanism to reduce risk of a gout attack, the researchers noted.
“Quarterly canakinumab administration was associated with significantly reduced risk for gout attacks without any change in serum uric acid levels,” the researchers concluded. “These data have relevance for the development of agents for gout that target the IL-1β pathway of innate immunity.”
—Melinda Stevens
Reference:
Solomon DH, Glynn RJ, MacFadyen JG, et al. Relationship of interleukin-1β blockade with incident gout and serum uric acid levels: exploratory analysis of a randomized controlled trial. [Published online September 18, 2018]. Ann Intern Med. https://doi.org/10.7326/M18-1167.
