Dumusc Alexandre, So Alexander
Department of Rheumatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland.
Curr Opin Rheumatol. 2015 Mar;27(2):156-63. doi: 10.1097/BOR.0000000000000143.
To give an overview of current evidence for interleukin (IL)-1 blockade in the management of gout.
Three IL-1 blockers are currently available for clinical use: anakinra, rilonacept and canakinumab. Recent studies have focused on drugs with a long half-life: rilonacept and canakinumab. For treatment of acute gouty arthritis, three randomized controlled trials (RCTs) showed efficacy of canakinumab with some safety concerns and one RCT failed to show efficacy of rilonacept. For prevention of gout flare when starting uric acid lowering therapy (ULT), four RCTs showed efficacy of rilonacept and one RCT showed efficacy of canakinumab.
There is sufficient evidence supporting the use of IL-1 blockers for treatment of acute gouty arthritis or for prevention of gout flares when starting ULT in selected patients, with contraindications or intolerance to conventional therapy. More data are needed to assess safety and to specify their use in routine practice.
概述白细胞介素（IL）-1阻断剂在痛风治疗中的现有证据。
目前有三种IL-1阻断剂可用于临床：阿那白滞素、rilonacept和卡那单抗。近期研究聚焦于半衰期长的药物：rilonacept和卡那单抗。对于急性痛风性关节炎的治疗，三项随机对照试验（RCT）显示卡那单抗有效，但存在一些安全性问题，一项RCT未显示rilonacept有效。对于在开始降尿酸治疗（ULT）时预防痛风发作，四项RCT显示rilonacept有效，一项RCT显示卡那单抗有效。
有充分证据支持在特定患者中，当有传统治疗的禁忌证或不耐受情况时，使用IL-1阻断剂治疗急性痛风性关节炎或在开始ULT时预防痛风发作。需要更多数据来评估安全性并明确其在常规实践中的应用。
