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  • Year in Review
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GOUT IN 2018

Prevention and treatment of gout

In 2018, advances in the treatment of gout flares came in the form of a new nurse-led management approach to serum urate lowering and evidence that allopurinol might have a better cardiovascular safety profile than febuxostat. However, are IL-1β blockers such as canakinumab the future of care for patients with gout?

Key advances

  • Nurse-led care can improve outcomes for people with gout and is cost effective2.

  • Febuxostat should be used with caution in people with gout and established cardiovascular disease3.

  • The IL-1β inhibitor canakinumab prevents incident gout without altering serum urate levels4.

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References

  1. Rai, S. et al. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology 57, 1282–1292 (2018).

    Article  Google Scholar 

  2. Doherty, M. et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 392, 1403–1412 (2018).

    Article  Google Scholar 

  3. White, W. et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N. Engl. J. Med. 378, 1200–1210 (2018).

    Article  CAS  Google Scholar 

  4. Solomon, D. et al. Relationship of interleukin-1β blockade with incident gout and serum uric acid levels: exploratory analysis of a randomized controlled trial. Ann. Intern. Med. 169, 535–542 (2018).

    Article  Google Scholar 

  5. Zhu, Y., Pandya, B. & Choi, H. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007–2008. Am. J. Med. 125, 679–687 (2012).

    Article  Google Scholar 

  6. Stamp, L., Day, R. & Yun, J. Allopurinol hypersensitivity: investigating the cause and minimizing the risk. Nat. Rev. Rheumatol. 12, 235–242 (2016).

    Article  CAS  Google Scholar 

  7. Schlesinger, N. et al. Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double blind trials and their initial extensions. Ann. Rhem. Dis. 71, 1839–1848 (2012).

    Article  CAS  Google Scholar 

  8. Schlesinger, N. et al. Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: results of a double-blind, randomised study. Ann. Rheum. Dis. 70, 1264–1271 (2011).

    Article  CAS  Google Scholar 

  9. Ridker, P. et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N. Engl. J. Med. 377, 1119–1131 (2017).

    Article  CAS  Google Scholar 

  10. Stamp, L. et al. Serum urate as surrogate endpoint for flares in people with gout: a systematic review and meta-regression analysis. Semin. Arthritis Rheum. 48, 293–301 (2018).

    Article  CAS  Google Scholar 

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Correspondence to Lisa K Stamp.

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Competing interests

L. S. declares that she has received speaker fees from Amgen and is currently a co-investigator on a clinical trial (ACTRN12615001219572) of intensive urate-lowering therapy (funded by the Health Research Council of New Zealand). N.D. declares that she has received speaking fees from AbbVie, Horizon, Janssen and Pfizer, consulting fees from Hengrui, Horizon and Kowa, research funding from Amgen and AstraZeneca and is currently principal investigator on a clinical trial (ACTRN12615001219572) of intensive urate-lowering therapy (funded by the Health Research Council of New Zealand). N.D. also declares that within the past 5 years she has been principal investigator on a clinical trial of febuxostat (NCT01078389) in early gout and has received consulting or speaking fees from Menarini, Takeda and Teijin.

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Stamp, L.K., Dalbeth, N. Prevention and treatment of gout. Nat Rev Rheumatol 15, 68–70 (2019). https://doi.org/10.1038/s41584-018-0149-7

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