Canakinumab for gout: a specific, patient-profiled indication

Abstract

The role of interleukin-1 (IL-1) in inflammation induced by crystals, and especially by monosodium urate crystals (MSUCs), has raised much interest in both basic and clinical investigation. Several drugs have been developed, and more are still in development, to block IL-1 driven inflammation, though to date only canakinumab (blocking IL-1β) has been labelled, yet limited to the European Union, with a restricted indication to treat episodes of acute inflammation (EAIs) in patients with gout in whom other therapeutic choices are unacceptable. Other medications developed for IL-1 blocking, such as anakinra and rilonacept, have been tested in gout patients in clinical trials, but lack label approval and may be further restricted to orphan indication in gout. Notwithstanding, the use of IL-1 blockade to prevent EAIs in gout looks promising, but no drug has yet obtained approval for such an indication.

Keywords::

• canakinumab
• gout
• gout suppressants
• IL-1
• monoclonal antibodies
• treatment

Financial & competing interests disclosure

This work was supported by an unrestricted grant from Asociación de Reumatólogos del Hospital de Cruces (Baracaldo, Vizcaya, Spain) 07/2013. F Perez-Ruiz has been a consultant for Ardea Biosciences, Astra-Zeneca, Menarini, Metabolex, Novartis and SOBI. The author has also received investigational funds from Ministerio de Sanidad, Gobierno de España, Sociedad Española de Reumatología, Asociación de Reumatólogos del Hospital de Cruces. The author was also involved in educational programs of Sociedad Española de Reumatología, Merck Sharp & Dohme, Menarini, Savient. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• IL-1 blocking using potent biologic agents to treat the episodes of acute inflammation in gout is a sound and effective pharmacodynamic approach to the physiopathology of inflammation induced by monosodium urate crystals.

• Although other agents have been used with off-label prescription or tested in clinical trials, only canakinumab has been approved, and to date only in the EU.

• Canakinumab has been shown to be effective and generally well tolerated for the treatment of the acute episodes of inflammation in gout, with the additional effect of delaying time to next episode after a single dose of 150 mg subcutaneously.

• Nevertheless, a higher rate of infections has been reported, although most were not serious.

• The restricted label and the commitment to screen for active or latent tuberculosis prior to administration situates canakinumab in clinical practice as a delayed therapeutic option rather than a handy one.

Notes