A pilot study of IL-1 inhibition by anakinra in acute gout

Alexander So¹ , Thibaut De Smedt² , Sylvie Revaz¹ and Jürg Tschopp³

¹Service of Rhumatologie, Department of Medicine, Centre Hospitalier Universtaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland

²Apoxis SA, Avenue de Sévelin 18-20, 1004 Lausanne, Switzerland

³Institute of Biochemistry, University of Lausanne, chemin de Boveresses 155, 1066 Epalinges, Switzerland

author email corresponding author email

Arthritis Research & Therapy 2007, 9:R28doi:10.1186/ar2143


Published:	12 March 2007

Abstract

Monosodium urate crystals stimulate monocytes and macrophages to release IL-1β through the NALP3 component of the inflammasome. The effectiveness of IL-1 inhibition in hereditary autoinflammatory syndromes with mutations in the NALP3 protein suggested that IL-1 inhibition might also be effective in relieving the inflammatory manifestations of acute gout. The effectiveness of IL-1 inhibition was first evaluated in a mouse model of monosodium urate crystal-induced inflammation. IL-1 inhibition prevented peritoneal neutrophil accumulation but TNF blockade had no effect. Based on these findings, we performed a pilot, open-labeled study (trial registration number ISRCTN10862635) in 10 patients with gout who could not tolerate or had failed standard antiinflammatory therapies. All patients received 100 mg anakinra daily for 3 days. All 10 patients with acute gout responded rapidly to anakinra. No adverse effects were observed. IL-1 blockade appears to be an effective therapy for acute gouty arthritis. The clinical findings need to be confirmed in a controlled study.