Abstract: SA-PO957

Experience with Interleukin-1 Blockade in Three Renal Transplant Patients with Severe Gout Arthritis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Goedecke, Vega, Hannover Medical School, Hannover, Germany
  • Einecke, Gunilla, Medical School Hannover, Hannover, Germany
  • Haller, Hermann G., Hannover Medical School, Hannover, Germany
  • Wagner, Annette D., Medizinische Hochschule Hannover, Hannover, Germany
Background

Hyperuricemia and gout are common comorbid conditions experienced by up to 28% of kidney transplant recipients. Reasons include reduced excretory renal function, intake of diuretic medication as well as side-effects of immunosuppressant drugs such as calcineurin-inhibitors. Treatment of gout in these patients remains a challenge, as uricostatic drugs such as allopurinol have a narrow therapeutic range in patients with impaired renal function whereas uricosuric medications such as benzbromarone are less effective due to reduced excretory renal function. Allopurinol and febuxostat are contraindicated when azathioprine is given, as they can cause severe drug interactions. Also, allopurinol therapy may increase cyclosporine plasma levels.
Interleukin 1 (IL-1) plays a crucial role in gout arthritis and its blockade with selective IL-1 inhibitors such as canakinumab or anakinra has shown promising results in the treatment of gout. Canakinumab was shown to be effective in preventing gout attacks in patients who had contraindications or were unresponsive to colchicine and/or non-steroidal inflammatory drugs. Data on the use of IL-1 blockade as treatment for gout in renal transplant patients are limited, therefore we present our experience with interleukin 1 blockade in 3 patients after renal transplantation. All of them had refractory gout arthritis despite various treatment regimens prior to starting IL-1 blockade therapy.

Methods

We present our clinical experience with anti-interleukin-1-antibody treatment in three renal transplant patients with gout arthritis. All of them had refractory gout arthritis despite various treatment regimens prior to starting IL-1 blockade therapy.
Two patients improved significantly and have had no gout symptoms since starting IL-1 blocking therapy. One patient suffered from pneumonia 1 month after starting therapy. Therefore, IL-1 blocking therapy was discontinued and the patient was started on rasburicase therapy.

Conclusion

Overall, therapy was well tolerated and symptoms improved in 2/3 patients. Therefore, Il-1 blocking therapy with canakinumab or anakinra is an option for treating refractory gout arthritis in renal transplant patients, even with chronic kidney disease stage 4. Infection was the main complication of therapy observed in our patients, therefore, close monitoring is recommended.