Abstract
Background: Acute gout flares cause severe pain, and conventional therapies are often contraindicated. Interleukin-1 (IL-1) inhibitors offer a targeted mechanism, but their efficacy and safety profile require systematic evaluation.
Methodology: This PRISMA-adherent systematic review and meta-analysis of 10 randomized controlled trials (n=1,731) assessed the efficacy and safety of IL-1 inhibitors (anakinra, canakinumab, rilonacept) versus active comparators or placebo.
Results: In the prespecified primary analysis (72-hour pain on VAS), IL-1 inhibitors provided significantly greater pain reduction versus controls (pooled mean difference -9.4 mm; 95% CI: -11.8 to -7.0; p<0.001), with low heterogeneity (I²=18%). Canakinumab was most effective (-11.7 mm; p<0.001). Time to symptom resolution was shorter with canakinumab (HR 1.62; p<0.001). Flare recurrence was significantly reduced for the drug class (RR 0.41; 95% CI: 0.29–0.58; p<0.001), an effect driven solely by canakinumab (RR 0.28; p<0.001). Injection site reactions were more common with IL-1 inhibitors (RR 4.18; p<0.001), but overall adverse events (RR 1.08; p=0.31) and serious adverse events (RR 1.12; p=0.64) were not significantly different from controls.
Conclusion: IL-1 inhibitors, particularly canakinumab, are efficacious for acute gout flares, offering superior pain relief and recurrence prevention with an acceptable safety profile, aside from injection site reactions.
Keywords
Gout, Acute gout flare, Interleukin-1 inhibitors, Anakinra, Canakinumab, Rilonacept, Randomized controlled trial, Systematic review, Meta-analysis, Pain reduction, Adverse events