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The Gout Dugout newsletter.Issue#010. Arcalyst sounds promising; Henry VIII's gout; Winter's coming.
October 01, 2008
A warm welcome to October's Gout Dugout
ARCALYST – IT MAY BE MORE HELPFUL THAN COLCHICINE OR NSAIDs.
The new gout drugs under development I wrote about in previous editions of The Gout Dugout, RDEA 594 and XOMA 052 are still in very early stages of development. So don't expect anything from these for years.
But Arcalyst recently completed its Phase 2 trials, and in early September its developers said they will start phase 3 trials among patients taking other uric acid lowering drugs (phase 3 usually take about three years) early in 2009. The U.S. based developers also plan to trial Arcalyst in other gout circumstances.
Arcalyst, once called Rilonacept (or IL-1 Trap), is not a tablet, it's injected. It has reduced gout attacks and gout pain in phase 1 and 2 trials. In the case of gout pain, when other treatments have failed.
In the phase 2 trials it reduced the average number of flares by 81% per patient compared to a placebo (dummy drug). Or putting the results another way, the developers said only 14.7% of study patients on Arcalyst suffered gout flares in the first 12 weeks and none of them had more than one attack.
In the FACT trial of febuxostat and allopurinol between 64% – 70% of study patients, taking febuxostat or allopurinol, suffered flares from weeks 8 to 52. Although I don't know how similar the FACT study patients were to those in the Arcalyst trial, Arcalyst looks promising.
Have you ever wondered ….. why do gout attacks occur when uric acid levels are falling and the MSU crystals are dissolving? This is a very good question and it is one of those at the heart of the whole gout mystery. There are others, but this is the one Arcalyst targets.
Colchicine was not found to be helpful in reducing gout pain, neither were NSAIDs, with this question fully understood at all. But Arcalyst does target this question and in a much more sophisticated manner. And its developers say, the theory explained below has been turned into a product for the first time.
At a simple level, (you would need to be a biochemist and know a lot about cell behaviour to understand it at a deeper level and so would I ), the theory is that during gout attacks and falling UA levels a cell excreted protein called Interleukin-1 (IL-1) is a leading cause of inflammation. Too much IL-1 is excreted from cells during gout attacks. Arcalyst inhibits IL-1 by attaching itself to IL-1 in the blood before it can return to the cells, when and where it begins the agony. Both are excreted from the body. Pretty clever.
The main hope seems to be that Arcalyst will work better than colchicine or NSAIDs in reducing the pain of gout attacks caused by falling uric acid levels. And work for those who can't tolerate colchicine or NSAIDs.
The potential is that it will see more people through the phase of gout attacks caused by falling uric acid levels and the dissolving crystals. These attacks discourage many gout patients from continuing allopurinol treatment. It's too early to say exactly whether this will also be true of febuxostat (EU brand name: Adenuric) but in its phase 3 trials, prior to EU approval, some patients also suffered gout flares which caused them to discontinue the trial. So this will almost certainly happen with febuxostat in the real gout world.
WINTER IS COMING
I hate to sound like a nanny and most people reading this will know or remember. But this newsletter gets new subscribers daily and some of them are new to the world of gout. So please bear with me when I state the obvious and say that winter coming in the Northern Hemisphere.
Cold weather and gout are friends. Do not forget to wrap up warmly whenever there are cold spells. Uric acid is more likely to crystallize in cold weather. And this may be why it's often said that there are more gout attacks in the (following) spring than at any other time. That is, crystallization begins during the winter and "erupts" in the spring. It's a bit vague I know, but why take a chance?
HENRY VIII's GOUT AND LAMPREYS
Whenever I read a biography of someone who suffered gout I always take careful note of what they ate and if it's stated, what their favourite foods were.
The English King Henry VIII (born1492 – died 1548) seems to have been a classic case of gout caused by high purine intake from food and alcohol. He ate extraordinary amounts of food, including a lot of foods we now know to be high purine, and over-drank for all his adult life. He is always portrayed as overweight from early middle age onwards, even at a time when painters were being paid to make people look good, then as now. Henry's favourite (favorite) foods? Lampreys, game pies and haggis.
Lampreys are an eel-like freshwater and coastal sea water fish. They are never listed on purine foods lists. Many game and haggis, (unless it's a veggie haggis) are on high purine lists,
In fact lampreys were widely eaten by the rich in Europe during the Middle Ages and Renaissance. Henry's contemporary rival, Charles V of the Hapsburg Empire also suffered gout.
Of course we don't know how much of these favourite foods he ate, and in case you like game pies and haggis I should say there's always scope to eat some high purine foods occasionally on a low purine diet. Just note that they don't trigger a gout attack.
Never heard of lampreys? Go on holiday to some countries in Europe (e.g. France, Spain and Portugal), and you'll find they are a delicacy. Now you wouldn't want a gout attack on holiday…..They are also eaten by a few in some other European countries, also I suspect by some in Australia and New Zealand, but not much in North America.
I am not just saying this about lampreys because of Henry VIII. There is an internet post from a gout sufferer who had his most serious attack of gout after eating a large dish of them.
CHERRIES OUT OF SEASON
Haven't stocked up with frozen cherries? Remember the free shipping offer on cherry and other useful fruit supplements, plus the Gout-Hater's Cookbooks, from Traverse Bay Farms I wrote about in the June edition. It's still on. If you wish to take advantage of this visit http://www.best-gout-remedies.com/cherries
from where you can order. But you do have to live in the continuous United States. Or visit www.best-gout-remedies.com/cherriescuregout.html
OOPS!In September's Gout Dugout in the section about orange juice for gout, I said that uric acid levels in the men fell by 37% and – 2.1. mg/dL. Actually on rechecking I found the reduction was –12.5% ( – 0.71 mg/dL). This is still a good reduction but it means that the reduction was NOT comparable to two weeks on a drug medication. And that the study's reduction numbers, in the men, were not necessarily higher than in the 2005 study I compared it to. Apologies for this error.
Next month there will be a feature on Benjamin Franklin's gout amongst other items.
P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact.Partial copying is not allowed.NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss remedies with your doctor or other health care professional before implementing any treatment.
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