Part 4 · Treatment & the future
The treatment ladder
Published guidance climbs one rung at a time: colchicine from the moment of clinical diagnosis, then the maximum tolerated dose, then IL-1 blockade added on top if attacks and inflammation persist. Press play to light the rungs in order, or click a rung to read what the guidelines say about it. This describes guidelines and trials, not advice for any person.
Click a rung to read it. Schematic, not to scale.
What the trials measured
Each group is a separate trial with its own design and endpoint, so bars are not comparable across groups. The attack-rate bars are the figures each trial published; the Cochrane re-analysis printed under them is more cautious, and found no clear difference for anakinra or rilonacept in the number of patients having attacks. 283
Sources, left to right: CLUSTER phase 3 randomised trial of canakinumab, 63 patients in the FMF cohort 44,283 · anakinra randomised trial, 25 colchicine-resistant patients 20 · rilonacept randomised alternating-treatment trial, 14 patients 93 · tocilizumab phase II and phase III trials 98,132.