New York Presbyterian Hospital/Columbia Medical Center, College of Pharmacy and Health Sciences, St. John's University, Queens, New York 11439, USA.
Pharmacotherapy. 2013 Jul;33(7):744-53. doi: 10.1002/phar.1265. Epub 2013 Apr 3.
Interleukin-1 (IL-1) inhibitors potentially have a role as antiinflammatory agents in refractory gout or for patients who are unable to tolerate conventional therapy, such as nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or glucocorticoids, for acute attacks. Additionally, IL-1 inhibitors may also help patients with polyarticular and tophaceous gout by making them less vulnerable to breakthrough attacks during initiation of chronic urate-lowering treatment, the mainstay of gout therapy. Because evidence highlights the role of proinflammatory cytokine IL-1 in the inflammation process during an acute gouty attack, IL-1 inhibitors are used to modulate the pathogenesis of a variety of autoinflammatory diseases, providing support for its potential role in the inflammatory process of gout. After NSAIDs, colchicine, and steroids, IL-1 inhibitors are beneficial as fourth-line therapy for acute gout attacks due to their high cost and limited clinical experience. The IL-1 inhibitors used in gout are anakinra, canakinumab, and rilonacept. Based on published evidence, anakinra has limited support in the form of anecdotal case reports to justify its use for treating gout. Canakinumab's toxic profile in clinical trials precludes its use in treating patients for gout, and rilonacept shows promise with a few well-designed studies to support its use in gout patients initiating urate-lowering treatment. When combined with current traditional therapies, these newer agents present clinicians and patients with more potential treatment options in the difficult-to-treat gout population.
白细胞介素-1（IL-1）抑制剂有可能作为抗炎药物用于难治性痛风或不能耐受常规治疗（如非甾体抗炎药、秋水仙碱或糖皮质激素）的急性发作患者。此外，IL-1 抑制剂还可以通过降低慢性尿酸治疗启动期间突破性发作的易感性，帮助多关节和痛风石性痛风患者，慢性尿酸治疗是痛风治疗的主要方法。由于证据突出了促炎细胞因子 IL-1 在急性痛风发作炎症过程中的作用，IL-1 抑制剂被用于调节各种自身炎症性疾病的发病机制，为其在痛风炎症过程中的潜在作用提供了支持。在 NSAIDs、秋水仙碱和类固醇之后，由于成本高和临床经验有限，IL-1 抑制剂作为急性痛风发作的四线治疗药物具有益处。用于痛风的 IL-1 抑制剂有阿那白滞素、卡那奴单抗和瑞立昔单抗。基于已发表的证据，阿那白滞素仅通过一些零星的病例报告提供了有限的支持，证明其可用于治疗痛风。卡那奴单抗在临床试验中的毒性特征使其不能用于治疗痛风患者，而利纳西普在一些设计良好的研究中显示出应用于开始降低尿酸治疗的痛风患者的潜力。当与当前的传统疗法联合使用时，这些新型药物为治疗困难的痛风患者提供了更多潜在的治疗选择。
