Firsekibart for steroid withdrawal in glucocorticoid-dependent refractory gout: a case report

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-1β (IL-1β) 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.