Data were evaluated on the efficacy and safety of gout flare prophylaxis and therapy in patients with chronic kidney disease (CKD), in a literature review published in Arthritis Research & Therapy.
Researchers of the current analysis searched PubMed, Cochrane Library, and EMBASE to identify studies that included patients with gout and renal impairment, and with exposure to colchicine, interleukin (IL)-1 inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids. All studies conducted between January 1, 1959, and January 31, 2018 were eligible in the review.
A total of 33 studies with safety and/or efficacy data, stratified by renal function, were identified: colchicine (n =20), anakinra (n =7), canakinumab (n =1), NSAIDs (n =3), and glucocorticoids (n =2). Another 58 studies reported similar primary outcomes, but without stratification by renal function: colchicine (n =29), anakinra (n =10), canakinumab (n =6), rilonacept (n =2), NSAIDs (n =1), and glucocorticoids (n =10).
Overall, the researchers highlighted the lack of conclusive data on efficacy and/or safety in gout flare prophylaxis and therapy in patients with underlying advanced CKD.
All the included studies reported pooled data, even when renal function was stratified at baseline. Furthermore, “It is evident that most clinical trials of gout flare prophylaxis and therapy excluded study participants with advanced CKD,” the researchers added.
Despite colchicine being considered a first-line anti-inflammatory treatment for gout flares, there are insufficient data on efficacy and safety in patients with gout and CKD. Researchers said, “Given the underlying risk [for] bias on study quality for these studies, we cannot sufficiently conclude on the efficacy and/or safety outcomes on colchicine use for people with gout and concomitant CKD.” Concerns were also noted about drug tolerance, specifically colchicine and anakinra toxicity, due to drug half-life and the use of other medications along with colchicine.
Lack of data were similar for IL-1 inhibitor use, which has been relatively unexplored. Most studies investigating NSAIDs focused on the nephrotoxic risk for this class of drugs. However, the researchers pointed out that it is still unknown whether NSAID use is effective and safe in patients with nonresidual renal function compared with those with normal renal function.
For glucocorticoid use, all the studies focused on refractory or very severe gout flare cases, which may not be reflective of common clinical care practice.
Limitations to the current review were that only English studies and published data were included. There were insufficient data on patients with gout flares and underlying renal transplant, therefore the findings may not be generalizable to this population. In addition, the heterogeneity of the study designs made quantitative analysis impossible.
Researchers recommended that future gout flare studies include this high-risk comorbid population and, “inform study results stratified by renal function as well as using standardised gout flare definitions in the study design.”
Pisaniello HL, Fisher MC, Farquhar H, et al. Efficacy and safety of gout flare prophylaxis and therapy use in people with chronic kidney disease: a Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)-initiated literature review. Arthritis Res Ther. 2021;23(1):130. doi:10.1186/s13075-021-02416-y