The aim of treatment for patients with gout flares is the rapid cessation of pain and inflammation. Standard anti-inflammatory treatments, such as NSAIDs and corticosteroids, might not be effective in all patients, and their use might be contraindicated in those with comorbidities such as renal impairment or diabetes. Biologic agents that inhibit interleukin 1β, such as anakinra and rilonacept, have shown promising results for the treatment of gouty arthritis. Another such agent, canakinumab, has now been studied in this setting.

In a multicenter, phase II, dose-ranging study performed by So et al., 200 patients with acute gouty arthritis who either did not respond to standard anti-inflammatory agents or who had contraindications against their use were randomly allocated to receive either a single dose of canakinumab (10, 25, 50, 90 or 150 mg; n = 143) or a single dose of triamcinolone acetonide (40 mg; n = 57). Pain was assessed on a 0–100 mm visual analog scale at baseline and then at 6, 12, 24, 48, 72, 96, 120 and 144 h post-treatment.

At 72 h, all doses of canakinumab were associated with a greater reduction in pain than triamcinolone acetonide 40 mg. However, only canakinumab 150 mg was associated with significantly reduced pain compared with triamcinolone acetonide at 24 h (P = 0.04), 48 h (P = 0.002) and 72 h (P <0.001) post-treatment. All doses of canakinumab also significantly reduced the risk of recurrent flares (P ≤0.01).

The authors conclude that the use of canakinumab for gouty arthritis warrants further study.