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Canakinumab Gives Faster, Greater Pain Relief in Refractory Gout Patients: Presented at ACR/ARHP

By Liz Meszaros

PHILADELPHIA -- October 25, 2009 -- Canakinumab provides faster and better pain relief than triamcinolone for acute flares in patients with gouty arthritis who are refractory to or contraindicated to standard treatments, according to data presented here October 20 at the 2009 Annual Scientific Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP).

In addition, a 150-mg dosage of canakinumab is more effective in preventing recurrence of gout flares than triamcinolone.

The 8-week, dose-ranging, multicentre, blinded, double-dummy, active-controlled study included 191 patients who were randomised to receive a subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg) or an intramuscular dose of triamcinolone acetonide 40 mg. Patients were assessed at 72 hours after dosing, and measured on a 0-100 mm visual analogue pain scale (VAS).

"Our cohort of patients represent the typical gout patient, in that they were primarily males in their fifth decade of life who had monoarticular gout," said lead author Alexander So, PhD, Service de Rhumatologie, Departement de Médecine, CHU Vaudois, University of Lausanne, Lausanne, Switzerland. "Patients had a mean of 6 flares and severe pain as registered on the VAS Score."

At 72 hours, a significant dose response was seen, with patients given the 150-mg dose reaching superior pain relief compared with those receiving triamcinolone, beginning from 24 hours. The estimated mean differences in pain intensity on the 0 to 100 VAS was -11.5 at 24 hours, -18.2 at 48 hours, and -19.2 at 72 hours (all P < .05).

Canakinumab 150 mg provided rapid onset pain relief, with the median time to 50% reduction in pain reached at 1 day, versus 2 days for those in the triamcinolone group (P = .0006).

"Very interestingly, canakinumab was also very effective in the prevention of gout flares," said Dr. So, noting that at the 150-mg dose, only 1 patient had an acute flare throughout the 8-week course of the study, compared with 25 patients in the triamcinolone group (3.7% vs 45.4%, respectively), for a relative risk reduction of 94% (P = .0006).

The use of rescue medication was also significantly reduced in the patients treated with canakinumab (22% in the 150-mg canakinumab arm vs 55% in the triamcinolone arm).

Canakinumab was well tolerated. "There were no significant differences in the rate of adverse events between the treatment arms," said Dr. So.

"Canakinumab at doses of 150 mg given subcutaneously has superior pain relief with a rapid onset of action when compared to triamcinolone. Canakinumab was also effective in preventing the recurrence of gout flare through the duration of this study," concluded Dr. So.

[Presentation title: Canakinumab (ACZ885) vs Triamcinolone for Treatment of Acute Flares and Prevention of Recurrent Flares in Gouty Arthritis Patients Refractory to or Contraindicated to NSAIDs and/or Colchicine. Abstract LB4]

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