Background/Purpose: Calcium Pyrophosphate Deposition Disease (CPPD) is a common inflammatory arthritis among older adults. Comorbidities often limit conventional treatment of acute CPPD flare. Anakinra, an interleukin-1 inhibitor, is a promising alternative. We aimed to evaluate the efficacy and safety of anakinra in acute CPPD flares.

Methods: We systematically searched studies from MEDLINE, EMBASE, and the Cochrane Database up until August 2024. The primary outcome was a positive treatment response between day 3 and day 5 after anakinra initiation. Secondary outcomes included changes in pain ratings assessed by the visual analog scales (VAS), C-reactive protein levels, tender joint counts (TJC), swollen joint counts (SJC) and corticosteroid usage.

Results: Six studies were included in our meta-analysis: five observational studies and one randomized controlled trial. A total of 84 patients were included in our analysis. Subjective physician assessments of clinical response were reported in all studies with a combined positive treatment response rate of 76% (95%CI: 61-86, I2=0%). Our pooled analysis also showed a significant reduction of VAS scores by 48.12 mm (95% CI: 53.21 – 43.03, I²=0%) and CRP levels by 62.09 mg/L (95% CI: 97.74-26.44, I²=77%) from baseline. Reductions of TJC and SJC were also demonstrated, 4.86 (95% CI: 5.48 – 4.23, I²=0%) and 3.65 (95% CI: -12.53-5.22, I²=54%), respectively. Adverse reactions included injection site reaction, rash, bacterial pneumonitis, and neutropenia.

Conclusion: Anakinra is a promising alternative treatment for patients with acute CPPD flare as it showed desirable clinical responses and a favorable safety profile.

Figure 1. The PRISMA Flow Diagram

Figure 2. Subjective Physician Assessment of Clinical Responses Following Anakinra Treatment for Acute CPPD Flares. The figure depicts the proportion of patients achieving clinical responses as evaluated by physicians after treatment with Anakinra.

Figure 3. Mean Differences in Secondary Outcomes Following Anakinra Treatment for Acute CPPD Flares. The figure depicts the mean differences in secondary outcomes measured between baseline and post-treatment with Anakinra. Secondary outcomes include: (A) Visual analog scale, (B) Total joint count, (C) Swollen joint count, (D) C-reactive protein levels, and (E) Steroid-sparing effects.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-anakinra-for-acute-calcium-pyrophosphate-deposition-disease-flare-a-systematic-review-and-meta-analysis/