Flares associated with gout can be highly disabling for patients, bringing a heightened risk for chronic pain that can lead to physical limitations that can have serious psychological, social, and financial impact. With an estimated 8 million individuals in the US affected by gout, the associated overall cost of care for those with the condition may be as high as it is with other severe chronic diseases.
By developing ways to decrease the incidence of the most common inflammatory arthritis, patients who suffer from gout can have increased wellbeing, and the burden of cost can be reduced. For a number of years, studies have concluded that interleukin-1 (IL-1) inhibitors can shorten gout attacks. What has been unclear is if IL-1 inhibitors can prevent them.
Recently, important learnings regarding these inhibitors have been gained from post hoc analysis of data from the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS). Though not designed to study gout, researchers continued their analysis with a secondary exploration of the data related to canakinumab and its effect on serum uric acid levels and the incidence of gout attacks. Participants of CANTOS all had a high-sensitivity C-reactive protein level and a history of myocardial infarction. Each of the 10,000 patients was assigned to a canakinumab group or a placebo group. They then received a subcutaneous dose every three months and a median follow-up at 3.7 years.
The results of this secondary analysis did not show that canakinumab affected serum uric acid levels over time, but they did reveal that for all dosages of canakinumab, there was a sizable reduction—equaling approximately 50%—in the incidence of gout attacks. This kind of outcome further opens the door to identifying new interventions for gout that target IL-1β. The findings from the secondary study add greatly to those from the primary, which showed that by inhibiting IL-1β there is a noted decrease in cardiovascular events and mortality from lung cancer.
Future guidelines may be able to map treatment plans that can improve upon the disease burden of patients with these chronic conditions. By being able to prescribe optimal treatments that can not only help control events from multiple comorbidities but also help prevent acute attacks and flareups from gout, providers could help control how all of these conditions impact the wellbeing of patients.
Ridker PM, et al. Anti-inflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017 Sep 21;377(12):1119-1131.
Solomon DH, et al. Relationship of Interleukin-1β Blockade with Incident Gout and Serum Uric Acid Levels: Exploratory Analysis of a Randomized Controlled Trial. Ann Intern Med. 2018 Oct 16;169(8):535-542.
Wertheimer A, et al. A revised estimate of the burden of illness of gout. Curr Ther Res. 2013 Dec;75:1-4.