Background/Purpose: Anakinra is a biologic response modifier that competitively antagonizes the biologic effects of interleukin-1β. Conventional treatments for the inflammatory response to acute gout are often contraindicated or can exacerbate comorbidities in medically complicated hospitalized patients. We report on the efficacy and safety of Anakinra for treatment of acute gouty arthritis in a medically complex in-patient cohort. Anakinra is not FDA approved for treatment of gout.

Methods: Retrospective chart review of all adult in-patients who received Anakinra in a 1017 bed hospital system from 2011 through 2015 in Rochester, New York. Only those patient treated for episodes of acute gouty arthritis were included. Data collected: demographics, medical comorbidities, prior treatments for gout, duration of hospitalization, concurrent infections, Anakinra dosing, response to treatment, adverse events.

Results: Of 28 adult in-patients receiving Anakinra over 5 years, 18 patients were treated for gout. The average age was 67.7 years. The average length of stay was 21.3 days. The average Charlson Comorbidity index¹ was 7.6. A representative patient with a Charlson Comorbidity index of 7 was scored as follows; age of 78 years old (3 points), CHF (1 point), prior MI (1 point), CKD 3 (2 points). Twelve of 18 cases were crystal proven at time of presentation. Average CRP during peak of symptoms was 163mg/dl. Average calculated GFR was 49ml/min. There were 3 transplant recipients (2 liver, 1 kidney) and 2 patients had implanted portable left ventricular assist devices. Seven patients were also receiving antibiotics at the time Anakinra was administered (Klebsiella pneumonia, 2 Enterococcal uti, C. difficile colitis, toe ulcer, 2 unknown). Thirteen of 18 patients had failed to respond to systemic corticosteroids and one to intraarticular treatment prior to receiving Anakinra. All patients responded to 1 or more doses of Anakinra. (Four of 18 responded to a single dose, 14 of 18 patients required 2 or 3 total doses). There was one adverse event for which Anakinra was a possible cause (worsening encephalopathy in decompensated liver failure patient).

Conclusion: Anakinra is an effective treatment for acute gouty arthritis in medically complex patients including those refractory to corticosteroids. Anakinra appears to be a safe treatment option for patients with extensive comorbid illnesses where conventional gout treatments may exacerbate comorbid diseases. The short half-life of anakinra is of additional utility for immunocompromised patients, such as solid organ transplant recipients, and patients with active infections. 1. Charlson, M et al. J Clin Epidemiol, 1994 Nov;47(11):1245-51. Validation of a combined comorbidity index.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/anakinra-is-effective-and-well-tolerated-in-medically-complex-patients-including-transplant-recipients-with-gout/