Anti-inflammatory agents for prophylaxis and flares

2016 ◽  
Author(s):  
Nicola Dalbeth
Keyword(s):  
Effective Treatment ◽  
Interleukin 1 ◽  
Safety Data ◽  
Acute Gout ◽  
Repeated Use ◽  
Anti Inflammatory ◽  
Concomitant Medications

Acute gout requires rapid, effective treatment. Colchicine, non-steroidal anti-inflammatories, and corticosteroids are all effective; the choice of agent is dictated by the patient’s co-morbidities and concomitant medications. Interleukin-1 inhibitors are effective, but the high cost precludes routine use, and long-term safety data for repeated use are lacking.

Difficult-to-treat gout flares: eligibility for interleukin-1 inhibition in private practice is uncommon according to current EMA approval

Rheumatology ◽  
2019 ◽  
Vol 58 (12) ◽  
pp. 2181-2187 ◽  
Author(s):  
Tristan Pascart ◽  
Laurène Norberciak ◽  
Hang-Korng Ea ◽  
Sahara Graf ◽  
Pascal Guggenbuhl ◽  
...  
Keyword(s):  
Interleukin 1 ◽  
Standard Of Care ◽  
Acute Gout ◽  
Second Line ◽  
First Line ◽  
Cross Sectional ◽  
The Past ◽  
Systemic Glucocorticoids ◽  
Anti Inflammatory ◽  
Gout Flares

Abstract Objective The objective was to determine the proportion of patients with difficult-to-treat or difficult-to-prevent acute gout attacks eligible for IL-1 inhibition. Methods Participants included in the French cross-sectional GOSPEL cohort (n = 1003 gout patients) were examined for contraindications and intolerance to standard of care (SoC) drugs of gout flares (colchicine, non-steroidal anti-inflammatory drugs and systemic glucocorticoids). Patients were classified as definitely eligible for first-line IL-1 inhibition (canakinumab) according to European summary of product characteristics (contraindications/intolerance to SoC and at least three flares per year) without any other anti-inflammatory options (contraindications/intolerance only), or potentially eligible (precaution of use). Eligibility to receive IL-1 during an on-going flare related to insufficient efficacy was assessed (second-line eligibility). Results Definite first-line eligibility for IL-1 therapy was found in 10 patients (1%) and contraindication to all SoC therapies in nine patients who had presented <3 flares in the past 12 months. At least precaution of use for SoC therapies was noted for 218/1003 patients (21.7%). Of 487 patients experiencing flares at baseline, 114 (23.4%) were still experiencing pain scored ⩾4/10 numeric scale on day 3, one of whom could not receive further SoC drugs. Only nine of them had three or more flares in the past year and were eligible for second-line IL-1 inhibition. Conclusion Despite significant numbers of patients without any SoC anti-inflammatory therapeutic options for gout flares, eligibility for IL-1 inhibition therapy according to current European approval is rare.

scholarly journals THU0423 ADHERENCE TO URATE-LOWERING THERAPY IN PATIENTS WITH SEVERE GOUT WHO RECEIVED СANAKINUMAB FOLLOWING A 5-YEAR RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 449.1-450
Author(s):  
M. Elisеev ◽  
O. Sheliabina
Keyword(s):  
Interleukin 1 ◽  
Symptomatic Treatment ◽  
Symptomatic Therapy ◽  
Lowering Therapy ◽  
Long Term Follow Up ◽  
Inflammatory Drugs ◽  
Acute Attacks ◽  
Anti Inflammatory

Background:The adherence to lowering therapy for gout is low, including in chronic severe gout. Whether interleukin 1 inhibitors may contribute to better adherence is unknown.Objectives:To compare adherence to urate-lowering therapy in patients with severe gout who received canakinumab versus patients who received standard anti-inflammatory therapy (NSAIDs, glucorticoids, colchicine).Methods:Of the 513 patients with gout observed at the V.A. Nasonova Research Institute of Rheumatology, Moscow from 2013 to 2014 y 247 patients with the most severe gout, requiring regular symptomatic treatment, were selected. Of these, 25 patients (3 (12%) women and 22 (88%) men), the average age of 54.5 ± 12.7 g, received (at least 1) canakinumab injection of 150 mg subcutaneously as a symptomatic therapy, the remaining 222 patients (men) mean age 51.9 ± 11.4 g. received standard anti-inflammatory therapy (colchicine (55% of patients), glucorticoids (5%), NSAIDs (40%), or a combination of these (3%). On average, after 4,8 ± 1.7 years, a comparative analysis of adherence to reducing therapy was carried out, as well as the need for anti-inflammatory therapy and assessment of adherence according to the Score compliance on the scale of the Moriscy-Green patients who received and did not receive canakinumab.Results:Evaluation was available in 180 patients (16 who received canakinumab and 164 who received standard anti-inflammatory therapy) who were initially given reducible therapy. 11 patients died (2 patients (8%) who received canakinumab and 9 (4%) patients on standard anti-inflammatory therapy), 56 patients (7 (28%) and 49 (22%), respectively) were not available for observation. Adherence to urate-lowering therapy was better in patients who received canakinumab (see table 1).Table 1.Score compliance on the scale of the Moriscy-GreenAdherence to therapyPatients receiving canakinumab, (n %)Patients receiving standard anti-inflammatory therapy, (n %)р=High (> 4 points)14 (87)83 (51)0,07Moderate (3 points)2 (13)46 (28)0,13Low (2 and <points)035 (21)0,03The likelihood of maintaining the target uric acid level when taking urate-lowering drugs in patients who previously received canakinumab was higher (12 patients (75%) who received canakinumab and 32 (20%) patients received standard anti-inflammatory therapy (p = 0.005).During the year preceding the analysis, there were no acute attacks of arthritis in 12 (75%) patients who received canakinumab and 46 (28%) patients received standard anti-inflammatory therapy (p = 0.002).132 patients who previously received regular anti-inflammatory therapy and received standard anti-inflammatory therapy and 1 patient (1 attack) (p = 0.005) who previously received canakinumab took anti-inflammatory drugs over the past year due to the development of exacerbations (an average of 3 seizures per year): NSAIDs (54%) or colchicine (46%).Conclusion:Therapy with interleukin 1 Kanakinumab may contribute to a better adherence to lowering therapy and isidentified with a lesser need for symptomatic therapy with long-term follow-up.Disclosure of Interests: :Maxim Elisеev Speakers bureau: Novartis, Menarini Group, Alium, Olga Sheliabina: None declared

Antioxidant and Anti-inflammatory Activities of Organic and Aqueous Extracts of Northeast Algerian Marrubium vulgare

2018 ◽  
Vol 16 (S1) ◽  
pp. S119-S129
Author(s):  
I. Namoune ◽  
B. Khettal ◽  
A.M. Assaf ◽  
S. Elhayek ◽  
L. Arrar
Keyword(s):  
Ethyl Acetate ◽  
Methanolic Extract ◽  
Ethyl Acetate Extract ◽  
Interleukin 1 ◽  
Total Phenolic ◽  
Dependent Manner ◽  
Aqueous Extracts ◽  
Traditional Use ◽  
Marrubium Vulgare ◽  
Anti Inflammatory

Marrubium vulgare (Lamiaceae) is frequently used in traditional medicine to treat many illnesses from ancient times. Its beneficial effects include antibacterial, antioedematogenic, and analgesic activities. This study was designed to evaluate the antioxidant and anti-inflammatory activities of organic and aqueous extracts of the leaves, the flowers, the stems, and the roots of Marrubium vulgare. The total phenolic and flavonoid contents as well as the antioxidant and the anti-inflammatory effects of methanol, chloroform, ethyl acetate, and aqueous extracts have been investigated by using different in-vitro methods. It was found that the ethyl acetate extract from Marrubium vulgare stems had the highest total phenolic content, while the ethyl acetate extract from the leaves yielded a high concentration of flavonoids. The ethyl acetate extract from the stems exhibited the highest activity in scavenging of 2,2-diphenyl- 1-picrylhydrazyl (DPPH), as well as in protecting erythrocytes. The leaves aqueous extract exhibited the highest ferrous chelating activity and its methanolic extract was found to be the strongest inhibitor of lipid peroxidation in β-carotene bleaching assay. The leaves chloroform extracts as well as the flowers methanol, chloroform, and ethyl acetate extracts were found to decrease the pro-inflammatory tumor necrosis factor alpha (TNF-α) cytokine levels in a dose-dependent manner. On the other hand, the flowers methanolic extract and the leaves methanol, ethyl acetate, and aqueous extracts decreased the interleukin-1 beta (IL- 1β) release. It was also found that the methanol extract from the flowers and the chloroform extract from the stems of Marrubium vulgare inhibited interleukin-8 (IL-8) release. This study provides a scientific basis for the traditional use of Marrubium vulgare as an anti-inflammatory agent and for the plant to be considered as an important resource of natural antioxidants.

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