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Introduction: Gout is a chronic condition manifested by painful periodic attacks of arthritis and progressive accumulation of monosodium urate in the body. Acute flares may be treated with nonsteroidial anti-inflammatory drugs (NSAIDs), analgesics, corticosteroids or colchicine. Therapeutic options may be limited in some patients with renal insufficiency. This patient population may require chronic oral corticosteroids if acute attacks are frequent and NSAIDs are contraindicated or colchicines is not tolerated. Steroid sparing options are needed in these instances. Etanercept is a tumor necrosis factor (TNF) inhibitor used in the management of many inflammatory disorders with known steroid sparing benefits. There has been only one case report in the literature of Etanercept use for gout with only 3 months of follow up. We initiated etanercept for prophylaxis and steroid sparing effects in three patients with renal insufficiency and are the first to provide long term follow up data.
Methods: Three patients with crystal proven tophaceous gout and renal insufficiency (serum creatinine 1.5, 1.4 and 3.4 respectively) who daily use of corticosteroids were given Etanercept at the standard dose (50mg/week). All were intolerant to colchicine. Case two was allergic to allopurinol. Case one and three could not achieve control of uric acid if allopurinol was adjusted to renal function. Average daily prednisone does for prophylaxis was 40 mg, 16 mg and 30 mg respectively.
Results: During first six months of therapy, two patients completely discontinued prednisone and case one decreased dose to an average 12 mg/day. This benefit has been durable for 22, 17 and 6 months respectively. Renal function has remained stable for all cases. Drug holidays have resulted in crystal proven flares in all three cases.
Discussion: These are the first reported cases of attenuation of frequent gout attacks with long term follow up. Clinical benefit and corticosteroid sparing effect was durable and challenged in all three cases. For complex patients with limited medical options, etanercept is worth considering for attenuation of frequent attacks and corticosteroid sparing effects.
Methods: Three patients with crystal proven tophaceous gout and renal insufficiency (serum creatinine 1.5, 1.4 and 3.4 respectively) who daily use of corticosteroids were given Etanercept at the standard dose (50mg/week). All were intolerant to colchicine. Case two was allergic to allopurinol. Case one and three could not achieve control of uric acid if allopurinol was adjusted to renal function. Average daily prednisone does for prophylaxis was 40 mg, 16 mg and 30 mg respectively.
Results: During first six months of therapy, two patients completely discontinued prednisone and case one decreased dose to an average 12 mg/day. This benefit has been durable for 22, 17 and 6 months respectively. Renal function has remained stable for all cases. Drug holidays have resulted in crystal proven flares in all three cases.
Discussion: These are the first reported cases of attenuation of frequent gout attacks with long term follow up. Clinical benefit and corticosteroid sparing effect was durable and challenged in all three cases. For complex patients with limited medical options, etanercept is worth considering for attenuation of frequent attacks and corticosteroid sparing effects.
C.T. Parker, Pfizer, Abbott labs, Cephalon, TAP, Sanofi, 8; K.J. Vanhuizen, None.