Anakinra Use Assessed in Hospitalized Patients With Crystal-Associated Arthritis

Uric acid crystal
Uric acid crystal
Investigators examined the efficacy and safety of anakinra in medically complex, hospitalized patients with acute gout and calcium pyrophosphate crystal arthritis.

In hospitalized patients with crystal-associated arthritis, including those with concurrent infections, transplant recipients, and individuals who have recently undergone surgical interventions, use of the interleukin-1 receptor antagonist anakinra has demonstrated safety and effectiveness, according to a large retrospective, observational study published in The Journal of Rheumatology.

Adult patients who were treated with anakinra between January 2014 and December 2017 at the University of Washington Medical Center and Harborview Medical Center in Seattle, Washington, were identified for inclusion in the study. All patient charts were reviewed with respect to demographics, laboratory data, comorbidities, joint involvement, pain scores, prior treatments, concurrent infections, surgeries, and dosing and response to anakinra.

A total of 100 patients, who accounted for 115 separate episodes of arthritis, were identified. The average patient age was 60 years and 82% of the patients were men. Patient comorbidities included chronic kidney disease or end-stage renal disease (45%), heart failure (43%), diabetes mellitus (27%), chronic anticoagulation use (22%), and history of organ transplantation that required antirejection immunosuppressant use (14%). Overall, 58% of participants had ≥2 of these comorbidities. Surgical interventions and infections were considered concurrent if they occurred during the index hospitalization and within 1 month of anakinra administration.

Concurrent infection was present in 34 of the episodes of arthritis and recent surgical interventions were associated with 29 of the arthritis episodes. The decision to use anakinra was based on a patient’s underlying comorbidities in 84% of the episodes and was because of failure of other treatments in 48% of the episodes, with some participants having both indications for the use of anakinra. Average duration of an arthritis episode prior to the administration of anakinra was 4.8 days.

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Overall, a complete or partial response to anakinra therapy was reported among 84 episodes of arthritis within 4 days of initiation of treatment, and 66 episodes of arthritis had a complete or partial response within 1 day of anakinra administration. The use of anakinra was well tolerated.

The investigators concluded that based on its rapid onset of action and favorable safety profile, anakinra should be considered for individuals with crystal-associated arthritis with concurrent infections, as well as for patients during the perioperative period and for those with immunosuppression following transplant.

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Liew JW, Gardner GC. Use of anakinra in hospitalized patients with crystal-associated arthritis [published online January 15, 2019]. J Rheumatol. doi:10.3899/jrheum.181018