- Design
- Double-blind, double-dummy randomised feasibility trial
- Population
- 21 adults with gout flare and chronic kidney disease (eGFR under 60)
- Primary outcome
- Feasibility criteria; pain reduction as a secondary measure
- Effect
- Mean pain fell 46.8 of 100 mm by day 7; anakinra numerically faster, unconfirmed
Treating an acute gout flare in chronic kidney disease is a common bind: non-steroidal anti-inflammatories are often contraindicated, and colchicine needs dose adjustment. The ASGARD feasibility trial tested whether the interleukin-1 blocker anakinra could be compared against intramuscular methylprednisolone in a future definitive trial.
It is a feasibility study, and it under-recruited: only 21 patients (mean age 72, mean eGFR 44) were randomised, with 17 treated per protocol. Mean pain fell by 46.8 points on a 100 mm scale by day 7 across the trial, and anakinra appeared to reach pain reduction faster, though the authors are explicit that this needs a larger trial to confirm. Procedural feasibility was partly met.
The value here is in framing the question, not answering it. Anakinra is a plausible option for gout flares in CKD, but this trial does not establish that it is better than a steroid; it argues that a proper trial is feasible with better community case-finding.
- Feasibility trial of anakinra versus intramuscular methylprednisolone for gout flares in CKD.
- Only 21 patients were randomised (mean age 72, mean eGFR 44); the trial under-recruited.
- Mean pain fell 46.8 points on a 100 mm scale by day 7 across the trial.
- Anakinra appeared to relieve pain faster, but this needs confirmation.
- The study shows a definitive trial is feasible, not that one drug is better.
Why it matters
It addresses a genuine everyday bind, treating gout when the kidneys rule out first-line drugs, without yet resolving it.
Don't overread it
With only 21 patients and under-recruitment, this feasibility trial cannot establish that anakinra is more effective than methylprednisolone.
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