Interleukin-1 beta inhibitors for the management of acute gout flares: a systematic literature review

Objectives The objective of this systematic review was to assess the effects of interleukin-1 beta (IL-1 beta) inhibitors on gout flares. Methods Studies published between 2011 and 2022 that evaluated the effects of IL-1 beta inhibitors in adult patients experiencing gout flares were eligible for inclusion. Outcomes including pain, frequency and intensity of gout flares, inflammation, and safety were assessed. Five electronic databases (Pubmed/Medline, Embase, Biosis/Ovid, Web of Science and Cochrane Library) were searched. Two independent reviewers performed study screening, data extraction and risk of bias assessments (Cochrane Risk of Bias Tool 2 for randomised controlled trials [RCTs] and Downs and Black for non-RCTs). Data are reported as a narrative synthesis. Results Fourteen studies (10 RCTs) met the inclusion criteria, with canakinumab, anakinra, and rilonacept being the three included IL-1 beta inhibitors. A total of 4367 patients with a history of gout were included from the 14 studies (N = 3446, RCTs; N = 159, retrospective studies [with a history of gout]; N = 762, post hoc analysis [with a history of gout]). In the RCTs, canakinumab and rilonacept were reported to have a better response compared to an active comparator for resolving pain, while anakinra appeared to be not inferior to an active comparator for resolving pain. Furthermore, canakinumab and rilonacept reduced the frequency of gout flares compared to the comparators. All three medications were mostly well-tolerated compared to their comparators. Conclusion IL-1 beta inhibitors may be a beneficial and safe medication for patients experiencing gout flares for whom current standard therapies are unsuitable.

Automated summary

This systematic review aimed to assess the effects of interleukin-1 beta (IL-1 beta) inhibitors on gout flares. The results showed that IL-1 beta inhibitors, including canakinumab, anakinra, and rilonacept, were effective in reducing pain and frequency of gout flares, and they were generally well-tolerated. These findings suggest that IL-1 beta inhibitors may be a beneficial and safe alternative for patients with gout flares who cannot tolerate standard therapies.