Gout is the most common inflammatory arthritis in humans. Current treatment options to control the pain and inflammation of acute and chronic gout include nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids. However, patients are commonly unresponsive to, intolerant of, or have contraindications to current treatments. Interleukin-1 (IL-1), a proinflammatory cytokine, plays a major role in mediating gouty inflammation. This role of IL- 1 has led investigators to explore a new class of antiinflammatory drugs that inhibit IL-1 signal transduction. IL- 1 inhibitors currently in trials for gout include anakinra, rilonacept, and canakinumab. Anakinra is an IL 1 receptor antagonist that inhibits the activity of both IL 1α and IL 1β, rilonacept is a soluble decoy receptor and canakinumab is an anti IL 1β monoclonal antibody. In case cohorts, anakinrawas found to be efficacious in combating acute gout pain and inflammation, whereas rilonacept has been found to be efficacious for reducing the risk of recurrent attacks. Canakinumab has been shown to be efficacious in both reducing pain and inflammation in acute attacks, and for reducing the risk of recurrent attacks. All three IL-1 inhibitors are generally well tolerated. This article reviews the current IL-1 inhibitors and the results of trials in which they have been tested for the management of acute and chronic gouty inflammation.
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