{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T19:21:46Z","timestamp":1774380106822,"version":"3.50.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Glucocorticoid dependence presents a major therapeutic hurdle in refractory gout, often preventing successful steroid tapering and perpetuating a cycle of recurrent flares. We describe a 53-year-old male with severe tophaceous gout and glucocorticoid dependence, experiencing frequent flares upon reducing methylprednisolone below 16 mg\/day despite urate-lowering therapy (ULT). After conventional anti-inflammatory agents proved inadequate, a single 200-mg subcutaneous dose of firsekibart (formerly known as genakumab), an anti-interleukin-1\u03b2 (IL-1\u03b2) monoclonal antibody, was administered. Following this intervention, gout flares ceased immediately, enabling a glucocorticoid taper and eventual discontinuation over the following two months. Inflammatory markers normalized, renal function stabilized, and serum urate decreased. This case demonstrates the potential of firsekibart as a potent steroid-sparing agent, effectively breaking the cycle of glucocorticoid dependency in refractory gout and enabling successful long-term management.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1785692","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T16:04:09Z","timestamp":1774368249000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Firsekibart for steroid withdrawal in glucocorticoid-dependent refractory gout: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Jinhui","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Health Management, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linghua","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Health Management, Jiangmen Wuyi Hospital of Chinese Medicine","place":["Jiangmen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruonan","family":"She","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunji","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2015.91","article-title":"Global epidemiology of gout: prevalence, incidence and risk factors","volume":"11","author":"Kuo","year":"2015","journal-title":"Nat Rev Rheumatol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s2665-9913(24)00117-6","article-title":"Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"6","year":"2024","journal-title":"Lancet Rheumatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1136\/annrheumdis-2016-209707","article-title":"2016 updated EULAR evidence-based recommendations for the management of gout","volume":"76","author":"Richette","year":"2017","journal-title":"Ann Rheum Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/art.41247","article-title":"2020 american college of rheumatology guideline for the management of gout","volume":"72","author":"FitzGerald","year":"2020","journal-title":"Arthritis Rheumatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.144063","article-title":"Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: results of a double-blind, randomised study","volume":"70","author":"Schlesinger","year":"2011","journal-title":"Ann Rheum Dis"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/nature04516","article-title":"Gout-associated uric acid crystals activate the NALP3 inflammasome","volume":"440","author":"Martinon","year":"2006","journal-title":"Nature"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/art.27600","article-title":"Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study","volume":"62","author":"So","year":"2010","journal-title":"Arthritis Rheum"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-025-03279-4","article-title":"Safety, tolerability, pharmacokinetics, and pharmacodynamics of Firsekibart, an anti-interleukin-1\u03b2 monoclonal antibody, in healthy Chinese participants: a randomized, double-blind, placebo-controlled phase 1 study","volume":"42","author":"Liu","year":"2025","journal-title":"Adv Ther"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.xinn.2025.101015","article-title":"Firsekibart versus compound betamethasone in acute gout patients unsuitable for standard therapy: a randomized phase 3 trial","volume":"6","author":"Xue","year":"2025","journal-title":"Innovation (Camb)"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-025-00790-6","article-title":"Efficacy and safety of Firsekibart compared to Etoricoxib for gout flares: a phase 2, multicenter, open-label, active-controlled, randomized non-inferiority trial","volume":"12","author":"Kong","year":"2025","journal-title":"Rheumatol Ther"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1169","article-title":"Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials","volume":"306","author":"Sundy","year":"2011","journal-title":"Jama"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.18433\/j3vw2f","article-title":"Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications","volume":"16","author":"Harirforoosh","year":"2013","journal-title":"J Pharm Pharm Sci"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1038\/nature01991","article-title":"Molecular identification of a danger signal that alerts the immune system to dying cells","volume":"425","author":"Shi","year":"2003","journal-title":"Nature"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20050640","article-title":"Blocking IL-1 in systemic inflammation","volume":"201","author":"Dinarello","year":"2005","journal-title":"J Exp Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key402","article-title":"Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial","author":"Janssen","year":"2019","journal-title":"Rheumatol (Oxford)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131226","article-title":"Rilonacept for gout flare prevention in patients receiving uric acid-lowering therapy: results of RESURGE, a phase III, international safety study","volume":"41","author":"Sundy","year":"2014","journal-title":"J Rheumatol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.70111","article-title":"Firsekibart as a prophylactic treatment for acute gout flare in participants initiating urate-lowering therapy: a phase 2, randomized, open-label, multicenter, active-controlled trial","volume":"7","author":"Yu","year":"2025","journal-title":"ACR Open Rheumatol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2016.09.020","article-title":"Efficacy and safety of febuxostat in 73 gouty patients with stage 4\/5 chronic kidney disease: a retrospective study of 10 centers","volume":"84","author":"Juge","year":"2017","journal-title":"Joint Bone Spine"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110092","article-title":"Safety and efficacy of febuxostat treatment in subjects with gout and severe allopurinol adverse reactions","volume":"38","author":"Chohan","year":"2011","journal-title":"J Rheumatol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112137-20250126-00222","article-title":"Expert consensus on urate-lowering therapy for high-risk hyperuricemia (2025 edition)","volume":"105","year":"2025","journal-title":"Natl Med J China"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.83332","article-title":"Changes in uric acid levels and effects on renal function after switching from febuxostat to dotinurad in patients with chronic kidney disease: a retrospective study","volume":"17","author":"Mima","year":"2025","journal-title":"Cureus"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1655502","article-title":"Switching from febuxostat to dotinurad, a novel selective urate reabsorption inhibitor, may substantially reduce serum urate levels, through URAT1 inhibition, potentially without adversely affecting ABCG2 function: findings from the SWITCH SURI study","volume":"16","author":"Osonoi","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2840-12-159","article-title":"Comparative effect of angiotensin II type I receptor blockers on serum uric acid in hypertensive patients with type 2 diabetes mellitus: a retrospective observational study","volume":"12","author":"Nishida","year":"2013","journal-title":"Cardiovasc Diabetol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1785692\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T16:04:11Z","timestamp":1774368251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1785692\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":23,"alternative-id":["10.3389\/fimmu.2026.1785692"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1785692","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"article-number":"1785692"}}