Acute gout attack in a peritoneal dialysis patient treated with Firsekibart: a case report

Objectives: Managing acute gout attacks in renal failure patients on peritoneal dialysis (PD) is challenging. We report a unique case of a PD patient with recurrent pulmonary infections, heart failure, and severe anemia, who presented with refractory gout attacks successfully treated with the IL-1β monoclonal antibody Firsekibart. Case presentation: A 52-year-old female PD patient experienced recurrent swelling and pain in limb joints for one year, with acute exacerbation for three days. Laboratory tests showed serum uric acid (UA) 627 μmol/L and C-reactive protein (CRP) 16.6 mg/L. Conventional treatments with nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids were ineffective. Given the patient's high inflammatory state and multiple comorbidities, Firsekibart (200 mg) was administered. Joint pain and swelling significantly improved within 24 h. The Visual Analogue Scale (VAS) score decreased from 5 to 1 within 72 h, and CRP dropped from 16.6 mg/L to 6.5 mg/L at day 3. UA decreased from 485 μmol/L to 388.9 μmol/L at day 7. At three-month follow-up, the patient remained free of gout recurrence, with VAS 1, CRP 7.8 mg/L, and UA 393 μmol/L. At the last 7-month telephone follow-up she reported no further acute gout attacks, though mild joint swelling persisted. No injection site reactions, hypersensitivity, or infectious complications were observed throughout the entire follow-up period. Conclusions: IL-1β blockade Firsekibart may represent a safe and effective option for managing acute gout attacks in high-risk ESRD patients on PD with multiple comorbidities.