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. 2023 Jul 25;25(1):128.
doi: 10.1186/s13075-023-03098-4.

Interleukin-1β inhibitors for the management of acute gout flares: a systematic literature review

Naomi Schlesinger  1 , Michael H Pillinger  2 , Lee S Simon  3 , Peter E Lipsky  4
Affiliations

Interleukin-1β inhibitors for the management of acute gout flares: a systematic literature review

Naomi Schlesinger et al. Arthritis Res Ther. .

Abstract

Objectives: The objective of this systematic review was to assess the effects of interleukin-1β (IL-1β) inhibitors on gout flares.

Methods: Studies published between 2011 and 2022 that evaluated the effects of IL-1β inhibitors in adult patients experiencing gout flares were eligible for inclusion. Outcomes including pain, frequency and intensity of gout flares, inflammation, and safety were assessed. Five electronic databases (Pubmed/Medline, Embase, Biosis/Ovid, Web of Science and Cochrane Library) were searched. Two independent reviewers performed study screening, data extraction and risk of bias assessments (Cochrane Risk of Bias Tool 2 for randomised controlled trials [RCTs] and Downs and Black for non-RCTs). Data are reported as a narrative synthesis.

Results: Fourteen studies (10 RCTs) met the inclusion criteria, with canakinumab, anakinra, and rilonacept being the three included IL-1β inhibitors. A total of 4367 patients with a history of gout were included from the 14 studies (N = 3446, RCTs; N = 159, retrospective studies [with a history of gout]; N = 762, post hoc analysis [with a history of gout]). In the RCTs, canakinumab and rilonacept were reported to have a better response compared to an active comparator for resolving pain, while anakinra appeared to be not inferior to an active comparator for resolving pain. Furthermore, canakinumab and rilonacept reduced the frequency of gout flares compared to the comparators. All three medications were mostly well-tolerated compared to their comparators.

Conclusion: IL-1β inhibitors may be a beneficial and safe medication for patients experiencing gout flares for whom current standard therapies are unsuitable.

Review protocol registration: PROSPERO ID: CRD42021267670.

Keywords: Anakinra; Canakinumab; Gout flare; Interleukin-1β; Randomised controlled trials; Rilonacept.

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Conflict of interest statement

NS has received research grant funding from Olatec and consulting fees from Horizon Therapeutics, Alnylam Pharmaceuticals, JW Pharmaceutical Corporation, LG chem, Sobi, Protalix and Novartis. MHP has served as a consultant to Swedish Orphan Biovitrum, Horizon Therapeutics, and Fortress Biotech and holds investigator-initiated grants for unrelated investigations from Hikma Pharmaceuticals and Horizon Therapeutics. LSS has financial relationships with Abbott, Abraxxis, AcelRx, Affinergy, Agenus, Alpha Rx, Alder, Alimera, Altea, Analgesic Solutions, Antares, Anthera, Array, Asahi, AstraZeneca, Avanir, Bayer, CaloSyn, Cephalon, Cerimon, Daiichi Sankyo, Dara, Dr. Reddy’s, DURECT, Eicos Sciences, Eli Lilly and Company, EMD Serono, Eupraxia, Extera, Fidelity, Flexion, Forest, Genco, Genzyme, Gilead, Hisamatsu, Horizon, Idera, Imprimis, Inmedix, Inotek, Jazz, JP Morgan, JRX Biopharm, Kiniksa, Knopp, Kowa, Leerink Swann, Luxor, Medac, Metabolex, Neos, Nomura, Novartis, NuvoResearch, Omeros, Parexel, Pfizer, PLx Pharma, Pozen, Proprius, pSivida, Purdue, Regeneron, Remedy, Rigel, Roche, Sammuded, Sandoz, Sanofi, Shire, Takeda, Talagen, Teva, TiGenix, Vical, Wyeth and XTL. PEL is an employee of AMPEL BioSolutions and has received consultant fees from Horizon Therapeutics.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the studies included in this review. Databases that were searched included PubMed/Medline, Embase, Biosis/Ovid, Web of Science, and Cochrane Library. N, number of studies
Fig. 2
Fig. 2
Summary of the Cochrane risk of bias assessment in included RCTs (A) overall and (B) in individual studies. Domain 1, randomisation process; domain 2, deviations from the intended interventions; domain 3, missing outcome data; domain 4, measurement of the outcome; domain 5, selection of the reported result. RCT, randomised controlled trial
See this image and copyright information in PMC

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