Anakinra or intramuscular steroid for gout flares in CKD: a feasibility trial that could not recruit

Design

Randomised, double-blind, double-dummy feasibility trial

Population

21 adults with gout flare and eGFR <60

Primary outcome

Feasibility (recruitment, retention, data completion)

Effect

Recruitment target missed (21 of 32); mean pain fall 46.8 mm at day 7

ASGARD, a UK double-blind, double-dummy feasibility trial, compared subcutaneous anakinra 100 mg daily for five days with a single intramuscular injection of methylprednisolone acetate 120 mg for gout flares in people with eGFR below 60.

Only 21 patients were randomised (mean age 72, mean eGFR 44) against a target of 32, so the trial failed its overall feasibility criteria. Pain fell by a mean of 46.8 mm on a 100 mm scale at day 7 across participants. Anakinra appeared to relieve pain sooner, but the authors stress this needs a larger trial.

The practical message is that the evidence for flare treatment in CKD remains thin. Participants reported delays in receiving treatment, which matters more in a flare than the choice of drug.

• No efficacy conclusion can be drawn from 21 patients; do not change practice on this result.
• A single intramuscular corticosteroid dose remains a practical flare option in CKD.
• Anakinra is used off-label for flares where other options are contraindicated; availability and cost limit it in India.
• Treat a flare early — delay was a recurring complaint from participants.

Why it matters

Patients with CKD are the ones in whom the usual flare drugs are most restricted, and the evidence for alternatives is still missing.

Don't overread it

This was a feasibility study; it was never designed to show whether anakinra works better.

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