Advances in pharmacotherapy for the treatment of gout

Abstract

Introduction: Gout is a common inflammatory arthritis affecting almost 6% of US males and 2% of US females. The central cause of gout is deposition of monosodium urate crystals, and the focus of treatment is aimed at crystal dissolution using urate-lowering therapy.

Areas covered: The review describes the current treatments for urate-lowering therapy including allopurinol, febuxostat, probenecid, benzbromarone and pegloticase. Anti-inflammatory treatment of acute flares and prophylaxis of flares with NSAIDs, colchicine, corticosteroids and anti-IL-1 agents is also reviewed. In addition, drugs in Phase III clinical trials for gout indications are reviewed.

Expert opinion: In the last decade, there has been major progress in the pharmacotherapy of gout. Management guidelines have emphasized the importance of a therapeutic serum urate target for effective gout management. Studies have identified the safe and effective dosing strategies for ‘old’ drugs such as allopurinol and colchicine. New therapeutic agents have been developed and approved for both urate-lowering therapy and anti-inflammatory treatment of acute flares. However, quality of care remains a major challenge in gout management, and strategies to ensure best practice require further focus to ensure that the progress of the last decade translates into clinical benefit for people with gout.

Keywords:

• allopurinol
• febuxostat
• gout
• pegloticase
• probenecid
• urate

Declaration of interest

Phillip Robinson is funded by the RACP-ARA-Starr Research Fellowship. N Dalbeth is supported by the Health Research Council of New Zealand (12-111). Phillip Robinson has consulted for and received research funding from AstraZeneca. N Dalbeth has received consulting, speaker fees or grants from the following companies: Takeda, Teijin, Menorini, Ardea, AstraZeneca, Savient, Fonterra and Metabolex. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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