Bardin Thomas
Head, Department of Rheumatology, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, University Paris VII, Paris, France.
Joint Bone Spine. 2015 Oct;82 Suppl 1:eS9-16. doi: 10.1016/S1297-319X(15)30003-8.
Many patients with gouty arthritis experience frequent flares and have comorbidities that may limit their anti-inflammatory treatment options for acute flare management. For patients with contraindications to both NSAIDs and/or colchicine, treatment options are particularly limited, and there is an unmet medical need in this subgroup of patients. Two phase 3 studies and their extensions have demonstrated that a single dose of canakinumab during an acute flare provided rapid and effective pain relief and prolonged suppression of flares and inflammation in patients with a history of frequent flares and contraindicated for, intolerant of, or unresponsive to NSAIDs and/or colchicine. Canakinumab was consistently superior to the active comparator triamcinolone acetonide and was generally well tolerated in this patient population with a high prevalence of multiple medical comorbidities. Canakinumab should therefore be considered as a treatment option in a target population of patients with frequent gouty arthritis attacks who are unable to use NSAIDs and colchicine and in whom frequent use of corticosteroids is not considered appropriate.
许多痛风性关节炎患者会频繁发作，且伴有可能限制其急性发作期抗炎治疗选择的合并症。对于非甾体抗炎药（NSAIDs）和/或秋水仙碱均有禁忌的患者，治疗选择尤为有限，这一亚组患者存在未满足的医疗需求。两项3期研究及其扩展研究表明，对于有频繁发作史且对NSAIDs和/或秋水仙碱禁忌、不耐受或无反应的患者，在急性发作期单次注射卡那单抗可迅速有效缓解疼痛，并长期抑制发作和炎症。卡那单抗始终优于活性对照药曲安奈德，在这一合并多种内科疾病患病率高的患者群体中总体耐受性良好。因此，对于频繁发作的痛风性关节炎患者，若无法使用NSAIDs和秋水仙碱且不适合频繁使用糖皮质激素，卡那单抗应被视为一种治疗选择。
