Objectives: Recent studies suggest that blockade of the NLRP3 (cryopyrin) inflammasome IL-1β pathway may offer a new treatment strategy for gout. This proof-of-concept study explored the potential utility of rilonacept (IL-1 Trap) in patients with chronic active gouty arthritis.
Methods: This 14-week, multicenter, nonrandomized, single-blind, monosequence crossover study of 10 patients with chronic active gouty arthritis included a placebo run-in (2-weeks), active rilonacept treatment (6-weeks), and a 6 week post-treatment follow-up.
Results: Rilonacept was generally well tolerated. No deaths and no serious AEs occurred during the study. One patient withdrew due to an injection-site reaction. Patients’ self-reported median pain VAS scores significantly decreased from Week 2 (following placebo run-in) to Week 4 (2 weeks of rilonacept) (5.0 to 2.8; P < 0.049), with sustained improvement at Week 8 (1.3; P < 0.049); 5 of 10 patients reported at least a 75% improvement. Median symptom severity-adjusted joint scores were significantly decreased. hs-CRP levels fell significantly.
Conclusions: This proof-of-concept study demonstrated that rilonacept is generally well tolerated and may offer therapeutic benefit in reducing pain in patients with chronic refractory gouty arthritis, supporting the need for larger, randomized, controlled studies of IL-1 antagonism such as with rilonacept for this clinical indication.
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