Background:
Anakinra, an IL-1 receptor antagonist, has been used successfully in acute gout flares, both as an effective treatment for acute gout, and as an alternative in patients whose comorbidities limit the use of other treatments, such as patients with diabetes or chronic kidney disease. While costs relative to other treatments may limit its use in the community, there is evidence that anakinra may act faster at inducing remission, which would make its use in hospitalised patients, with more severe or refractory gout flares, attractive. But despite this, there is no published data on the effect it has on hospital length of stay (LOS) in patients with acute gout flares. The purpose of this study was to audit the LOS in patients treated with anakinra at our institution
Methods:
In 2020, anakinra began being used in selected patients admitted to our facility with an acute gout flare. Anakinra was given subcutaneously at a daily dose of 100mg. No screening for latent infections was performed prior to the use of anakinra. Baseline data was collected from these patients prospectively, as well as dates and number of doses of anakinra. To measure whether anakinra resulted in any difference in LOS, the senior rheumatologist in our department, who was responsible for inpatient care in both 2019 and 2020 was presented with deidentified data from patients admitted with an acute gout flare in 2019, blinded to the actual LOS, and asked which patients he would use anakinra in had it been available at the time, based on the patient characteristics including CRP levels, mobility impairments, and joint count.
Results:
During the period from the beginning of 2020 to April 2021, seven patients were treated with anakinra whilst admitted to our institution with an acute gout flare as the primary reason for hospital admission. Thirteen patients were selected by the senior rheumatologist from the 2019 cohort as being patients he would use anakinra to treat their acute gout flare had it been available at the time. The baseline characteristics between the two groups were similar. The mean LOS for patients receiving anakinra was 5 days, compared to 6.8 in the control group, which did not reach significance (p=0.41). While the mean LOS from the time of first dose of anakinra to the time of discharge was 3.2 days compared to a mean LOS of 6.8 days in the control group (p=0.095). No adverse events were recorded in the anakinra group.
Conclusion:
While we cannot say that anakinra reduces LOS, we have begun using it as a treatment with promising signs and without any apparent safety concerns.