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Good News for Gout Sufferers
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Posted on: 04/21/2010
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If you've had gout for a long time or you are a new patient with gout, this report will be of interest to you. After years without new hope for treatment, safer and more effective medications are now available.
Gout is a form of arthritis with joint inflammation. It's caused by too much urate (uric acid) in the body because of a missing enzyme (uricase). Excess uric acid causes needle-shaped crystals to form in the synovial (joint) fluid. One of the most distressing symptoms of gout is painful, inflamed, hot, and tender joints. The big toe is affected most often but other joints can become symptomatic, too.
For the last 40 years, treatment has focused on diet to reduce urate levels. Painful inflammation is managed with nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids. But not everyone can take these medications. These drugs are often off-limits for some patients with gout who also have diabetes, high blood pressure, or kidney problems.
Despite the need for an alternative approach to gout, no new medications have been developed until just recently. In 2009, the Food and Drug Administration (FDA) approved a group of new drugs for the treatment of gout. These new medications are the subject of today's review and include colchicine, anti-interleukin (IL)-1 beta therapy, urate transporter (URAT1) inhibitors, febuxostat, and uricase replacement.
The first drug mentioned (colchicine) isn't really new. It's been used for gout for 200 years. But the FDA has never formally approved it. As a result of reviewing the effectiveness and safety of this drug, a new nongeneric drug (Colcrys) has been developed, approved, and is now available. Colcrys has the advantage of stopping the gouty attack quickly but it only worked for half the people who tried it.
Anti-interleukin therapy is a biologic approach designed to prevent the inflammation associated with gout. These medications can also be used to treat inflammation once it begins. Three of these anti-interleukins (Anakinra, Rilonacept, and Canakinumab) are being tested and studied in humans.
So far, Anakinra has been effective in reducing 50 per cent of the painful symptoms associated with gout and it does so within 48 hours. Rilonacept provided 75 per cent pain relief for half of the patients who took it and prevented symptoms in three-fourths of the patients who took it prophylactically (to prevent joint inflammation). Canakinumab is faster in delivering relief from pain (within 24 hours) and seemed to be able to prevent recurrent attacks later.
Besides treating the symptoms of a gouty attack, modern treatment now has new agents to reduce urate levels. This can be done by helping the body get rid of the excess urate or by keeping the body from making so much urate in the first place.
Febuxostat is a new drug that does both at the same time. Compared with the drug that's been in use since 1963 (Allopurinol), Febuxostat is almost twice as effective. And Febuxostat can be used by patients who have kidney problems if they don't already have severe kidney failure.
You might think that if gout is caused by a lack of uricase enzyme, why not just replace the missing ingredient? Good idea! But uricase replacement isn't that easy. It requires intravenous (IV) delivery and the effect doesn't last. And in some people, infusion (IV drug delivery) causes an immune reaction to the drug. The IV drug is also very expensive and inconvenient. For now, this approach is used with a small number of patients who can't take Allopurinol or who have not responded to other treatment.
In summary, drug companies have turned their attention to finding better, safer ways to prevent, treat, and manage gout. Successful elimination of painful joint symptoms will be appreciated by the increasing number of adults who suffer from this on again/off again condition. Studies are in the early phases with human trials right now. Results look promising, but time will tell.
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References:
Aryeh M. Abeles, MD, and Michael H. Pillinger, MD. New Therapeutic Options for Gout Here and on the Horizon. In The Journal of Musculoskeletal Medicine. March 2010. Vol. 27. No. 3. Pp. 93-100.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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