SAT0367 Low-Dose Anakinra is Effective for the Prophylaxis of Acute Episodes of Inflammation In Severe Tophaceous Gout.
Authors: F. Perez-Ruiz, A. M. Herrero-Beites, A. Alonso-Ruiz, J. Atxotegi, M. R. Lopez-Santamaría, M. de Miguel
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> anakinra has been used off-label for the treatment of severe episodes of acute inflammation (EAIs) in gout [1], only a small retrospective series of 3 patients reported as prophylaxis with intermittent schedule [2]. <h3>Objectives</h3> to explore whether a low-dose prescription of anakinra would be useful in patients with severe gout and contraindication of other current treatments for prophylaxis of AEIs when starting urate-lowering therapy (ULT). <h3>Methods</h3> patients with crystal proven arthritis, tophaceous gout, and severe, recurrent EAIs showing aformal contraindication for current treatments for prophylaxis and requiring repeated doses of parenteral corticosteroids were included in a cohort for follow-up. All patients were scheduled to start ULT and receive anakinra 100 mg sc once a week with additional 100 mg doses on demand during the first 3 months and only on demand dosing from month 3 to 6. AEIs were evaluated using the EULAR-ACR preliminary criteria for self-referred AEIs in gout [3] and expressed as events/patient-year observation. Clinical evaluation and anaylsis (hemogram, full biochemistry including urate, estimated GF -CKD_EPI - and high sensitivity CRP) were monitored at baseline and months 3 and 6. <h3>Results</h3> nine patients were included in the protocol, but 1 of them was excluded from analysis as he was shown to suffer also from crystal-proven chronic pyrophosphate inflammatory arthritis [4]. Mean age was 58±16 years (39-79), time with gout 9±4 years (5-16), polyarticular 75%. CHF was present in 4/8, CKD 3-4 in 6/8, serious AEs to NSAIDs in 6/8 and diabetes or steroid-induced hyperglycemia in 6/8. Results are shown in Table. In the 0-3 period, only 2/8 required additional doses, and 4/8 while only on demand from mo 3-6. A patient had an episode of heart failure (4<sup>th</sup> in a year) but was maintained on treatment without further complications to date. <h3>Conclusions</h3> this small sized pilot study is, to our knowledge, the first to explore in pre-established doses the efficacy of low-dose anakinra for the prophylaxis of AEIs in patients with severe comorbidities and severe tophaceous gout. These encouraging results deserve further studies. <h3>References</h3> So A, DeSmedt T, Revaz S, Tschopp J. A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther 2007;9:R28. Tran AP, Edelman J. Interleukin-1 inhibition by anakinra in refractory chronic tophaceous gout. Int J Rheum Dis 2011;14:e33-e37. Gaffo AL, Schumacher HR, Saag KG, Taylor WJ, Dinnella J, Outman R et al. Developing a provisional definition of a flare in patients with established gout. Arthritis Rheum 2012; 64: 1508-17. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis 2011. <h3>Disclosure of Interest</h3> F. Perez-Ruiz Consultant for: Ardea, Savient, Menarini, Astra, Metabolex, Pfizer, Novartis, SOBI, Speakers bureau: Menarini, A. Herrero-Beites: None Declared, A. Alonso-Ruiz: None Declared, J. Atxotegi: None Declared, M. Lopez-Santamaría: None Declared, M. de Miguel: None Declared