New Treatments & Drugs for Gout Flare-ups

New Treatments & Drugs for Gout Flare-ups
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Completed Studies with Results

Here are two drugs studied in clinical trials on current research in treating gout flare-ups with published results. The sponsor is listed after the drug name, followed by the Clinical Trials database identifier. Publications are listed in the References section.

Febuxostat and Allopurinol

Febuxostat was more effective in lowering urate levels than allopurinol in one test. In another study, either drug nearly eliminated gout flares. However, in another report febuxostat, while effective in stopping the flare-ups, seemed to result in more frequent episodes [1]. Takeda Global Research & Development Center, Inc. NCT00430248

Canakinumab. Novartis Pharmaceuticals. 862-778-8300. NCT00927810 (completed but no published results)

MPC-4 (Colchicine). Some positive results with most prevalent adverse effect being diarrhea.

Studies Recruiting Volunteers

These clinical studies are recruiting volunteers, some of which have multiple study locations. They are listed with the name of the drug, the sponsor, contact information and the Clinical Trials identifier (search https://www.clinicaltrials.gov/ with this identifier for more information). Please note: Studies may close recruitment. Always verify using the clinicaltrials database.

  • Rilonacept. Regenereon Pharmaceuticals. Brian Ford. 919-240-5259. NCT00855920
  • Oral BCX4208. BioCryst Pharmaceuticals. William P. Sheridan, MB BS NCT 00985127
  • Apremilast. Dartmouth-Hitchcock Medical Center. Robert Wortmann, MD NCT00997581
  • Uricase-PEG 20. EnzymeRX. Rocelle Flores, 201-843-4424, ext. 203. NCT01038947
  • MBX-102 and Allopurinol. Brian Roberts, MD. 510-293-8800. NCT1399008

Publications from Clinical Studies

A 2009 German study claimed that pharmacological intervention should only enter the picture if gout is clinically manifest, i.e., not if hyperuricemia, which causes gout, is asymptomatic. If it was clinically significant, this review recommended allopurinol or benzbromarone. Otherwise, the article suggested treating gouty attacks with short-term use of non-steroidal anti-inflammatory drugs, colchicines or glucocorticosteroids. [2]

A review article from the Roger Williams Medical Center, Rhode Island agrees with other current research in treating gout flare-ups by claiming that trying to manage hyperuricemia should only be attempted once the symptoms of an acute gout attack have been brought under control with high-dose half-life NSAIDs. If the patient cannot tolerate NSAIDs because of other comorbidities, then systemic corticosteroids may be used. [3]

In 2006, the medical journal Current Rheumatology Reports published an article discussing the uricosuric (uric acid-lowering) effects of drugs that are normally prescribed for other conditions. These included losartan, atorvastatin, and fenofibrate. [4]

Drug Side Effects

Almost all pharmaceutical products can have side effects, which vary in severity and importance. Gout drugs are no different. Here are some reported side effects from traditional and newer treatments:

  • NSAIDs. Upset stomach, bleeding, kidney damage
  • Colchicine. Peripheral neuritis, muscular weakness, nausea, vomiting. Generic versions may not be bioidentical to the trade-name version. [5]
  • Probenecid. Headache, dizziness, vomiting, nausea, anorexia
  • Corticosteroids. Sodium retention, joint damage with overuse, inflammation
  • Allopurinol. Upset stomach, skin rash, white blood cell increase, liver or kidney damage
  • Febuxostat. Liver function abnormalities, nausea, arthralgias, rash
  • Canakinumab. Nasopharyngitis, diarrhea, influenza, rhinitis, nausea
  • Rilonacept. Injection-site reaction, upper respiratory tract infection, nausea, diarrhea, sinusitis
  • Oral BCX4208. Not yet reported.
  • Apremilast. Not yet reported. Clinical study not yet recruiting
  • Uricase-PEG 20. Not yet reported. Study began December 2009

References

[1]. Arthritis and Rheumatism, Effects of Febuxostat versus Allopurinol and placebo in reducing serum urate . . . ., Nov. 15, 2008. <em>New England Journal of Medicine</em>, Febuxostat compared with allopurinol in patients with hyperuricemia and gout. 2005. Journal of Rheumatology, Clinical efficacy and safety of successful long term urate lowering with febuxostat or allopurinol . . . . 2009

[2]. Deutsches Artzeblatt International. Gout—current diagnosis and treatment. 2009

[3]. Medicine and Health, Rhode Island, Diagnosis and management of acute gout, 2009

[4]. Current Rheumatology Reports, New developments in clinically relevant mechanisms and treatment of hyperuricemia, 2006.

[5] Merck Manual of Medical Information. Second Edition. Merck, 2003, p. 90

[6] MPC-004 for the Treatment of an Acute Gout Flare (AGREE)

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