Arcalyst (the brand name for rilonacept) is included in my gout pain relief guide. So, despite getting rejected last year by the FDA, it remains a potential treatment. Though colchicine, NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), and steroids remain as the main forms of gout pain relief, some gout patients cannot tolerate these. Arcalyst is touted as a fourth option, together with similar drugs in the pipeline.
Inflammation Blockers For Gout
In my gout pain relief guide, I included pipeline drugs: rilonacept (Arcalyst); canakinumab (ACZ885); infliximab (Remicade); and anakinra (Kineret). Arcalyst was turned down last year, but the option to re-submit an amended application has remained. I have no knowledge of a pending application, but when I see 5 studies on rilonacept published so far this year, my crystal ball starts twitching. Do not be surprised if a new application is submitted soon. I will wait until that happens before reviewing gout studies in detail, but here are a couple of recent reports relating to inflammation blockers for gout.
I’ll look at the most recent first, as this looks at inflammation blockers in general.
In Role of Interleukin-1 Inhibitors in the Management of Gout, Tran and colleagues review the current status of inflammation blockers for gout management. They explain that Interleukin-1 (IL-1) is a substance produced by cells in our immune system during a gout attack that is associated with inflammation. By blocking this natural chemical response, we can expect to relieve or prevent, gout pain. However, IL-1 blockers are expensive and new, therefore they should only be considered where the main forms of gout pain relief fail.
The review considers anakinra, canakinumab, and rilonacept. Anakinra is dismissed as having “limited support.” Canakinumab is dismissed for it’s “toxic profile.” That leaves rilonacept (Arcalyst) as the winner in the race for potential inflammation blockers for gout.
However, winning a race for potential is not the real objective. We really want to know when Arcalyst will be available as a fourth choice for gout pain relief. We do not know this yet, but there are promising signs in the latest results from international randomized placebo-controlled trials (PRESURGE-2).
In Rilonacept for gout flare prevention during initiation of uric acid-lowering therapy, Mitha and colleagues report on clinical trials to assess the safety and efficacy of Arcalyst for gout. They conclude:
Rilonacept significantly reduced the occurrence of gout flares associated with initiation of uric acid lowering therapy, with more than 70% of patients having no flares, and demonstrated an acceptable safety and tolerability profile.
Arcalyst For Gout: Next Steps
If you have any opinions, or insider knowledge, about when we will see the next application for Arcalyst for gout, please share in the gout forums. It would also be nice to read your story if you are one of the likely candidates who are currently unable to use mainstream gout pain relief.