Transl Androl Urol. 2026 Jun 30;15(6):224. doi: 10.21037/tau-2026-0406. Epub 2026 Jun 25.
ABSTRACT
BACKGROUND: The management of acute gout flares in elderly patients with multiple comorbidities remains a significant clinical challenge. Although interleukin-1β (IL-1β) inhibitors are recommended for refractory gout when conventional therapies are unsuitable, evidence remains limited regarding their use in patients with active malignancy and moderate-to-severe renal impairment. This case addresses the knowledge gap in balancing potent anti-inflammatory therapy with complex oncological and renal risks.
CASE DESCRIPTION: We report a case of a 73-year-old male patient with refractory gout, a disease duration exceeding 20 years, and extensive tophus formation. The patient was concomitantly diagnosed with acinar adenocarcinoma of the prostate, stage 3 chronic kidney disease (CKD), coronary artery disease, and grade 3 hypertension. Due to recurrent acute gout flares, impaired renal function, and a high risk of bleeding, standard anti-inflammatory therapeutic options were contraindicated. After a comprehensive assessment of the potential risks and benefits, treatment was initiated with firsekibart, a novel fully human monoclonal antibody targeting IL-1β, administered as a single 200 mg subcutaneous injection, in combination with a short course of low-dose glucocorticoids. Urate-lowering therapy with febuxostat was subsequently introduced. Marked relief of joint pain and swelling was observed within 24 hours of treatment. During the 3-month follow-up period, inflammatory markers improved substantially, with high-sensitivity C-reactive protein decreasing from 62.36 to 0.9 mg/L. Target serum urate levels were achieved (444.9 µmol/L), and renal function showed improvement, as evidenced by an increase in the estimated glomerular filtration rate from 36.4 to 44.9 mL/min/1.73 m2. No evidence of tumor progression, serious infections, or major cardiovascular adverse events was observed in the follow-up period.
CONCLUSIONS: This case suggests that firsekibart may provide rapid and effective inflammation control in high-risk gout populations where standard treatments are limited. These findings highlight the potential of IL-1β targeted therapy as a precision medicine approach for complex patients; however, larger prospective studies are required to validate the long-term oncological and renal safety profile of firsekibart in this population.
PMID:42436784 | PMC:PMC13355260 | DOI:10.21037/tau-2026-0406