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Joint Bone Spine
Volume 85, n° 6
pages 755-760 (décembre 2018)
Doi : 10.1016/j.jbspin.2018.03.015
accepted : 4 Mars 2018
Original Articles

Effectiveness and safety of anakinra in gout patients with stage 4–5 chronic kidney disease or kidney transplantation: A multicentre, retrospective study
 

Clotilde Loustau a, Nicolas Rosine b, Marine Forien c, Sébastien Ottaviani c, Pierre-Antoine Juge b, Frédéric Lioté b, c, Thomas Bardin b, c, Pascal Richette b, c, Philippe Dieudé c, d, Christophe Richez a, e, Bernard Bannwarth a, Thierry Schaeverbeke a, e, Hang-Korng Ea b, c, , 1, Marie-Elise Truchetet a, e, , 1
a Service de rhumatologie, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France 
b Service de rhumatologie & Inserm UMR 1132 BIOSCAR, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique–Hôpitaux de Paris, 75010 Paris, France 
c Faculté de médecine, university Paris-Diderot, Sorbonne-Paris-Cité, 75013 Paris, France 
d Service de rhumatologie, hôpital Bichat, Assistance publique–Hôpitaux de Paris, 78018 Paris, France 
e Immunoconcept, CNRS UMR 5164, Bordeaux University, Bordeaux 33076, France 

Corresponding author. Service de rhumatologie, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.Service de rhumatologie, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
Highlights

Anakinra is well-tolerated during the treatment of gout flares in stage 4-5 CKD patients.
Anakinra has a good effectiveness for the treatment of gout flares in stage 4-5 CKD patients.
Treatment duration needs recommendations.

The full text of this article is available in PDF format.
Abstract
Objectives

Interleukin (IL)-1β blocking is effective for the treatment of gout flares and is recommended in patients with contraindications to the standard of care, such as stage 4–5 chronic kidney disease (CKD) patients. However, efficacy and safety data regarding these agents are lacking in this population. We aimed to investigate the efficacy and safety of anakinra for the treatment of gout flares in patients with stage 4–5 CKD or renal transplantation.

Methods

This retrospective study encompassing 3 academic centres included consecutive patients with stage 4–5 CKD or kidney transplantation who received anakinra for the treatment of acute gouty arthritis and completed at least one follow-up visit. Efficacy, occurrence of infection, and renal function variations were recorded.

Results

Of the 31 included patients (24 men, mean age 72±11 years), 25 were non-transplant subjects with stage 4–5 CKD (mean estimated glomerular filtration rate, MDRD formula (eGFR) 22.7±6.5mL/min/1.73m2), and six had undergone kidney transplantation (mean eGFR 41.5±22.8mL/min/1.73m2). Median gout duration was 3.5 years, and the mean serum urate (SUA) level was 8.7mg/dL. Twenty-one (68%) patients had tophi, and 21 had gout arthropathy. Anakinra was efficacious in all patients (final VAS 10 and CRP level 10mg/L). Ten patients (32%) were anakinra dependent (i.e., required prolonged treatment with anakinra). A serious infection was recorded in only one patient, occurring 3 months after starting anakinra. No significant variation in renal function was observed.

Conclusion

Anakinra may be a safe therapeutic option for gout patients with advanced CKD. Further randomized controlled studies are required to confirm our results.

The full text of this article is available in PDF format.

Keywords : Gout, Anakinra, Safety, Stage 4–5 chronic kidney disease, Kidney transplantation


1  These authors equally contributed to this work.


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