Pegloticase and the patient with treatment-failure gout

Abstract

Gout is an inflammatory arthritis characterized by sudden, painful inflammation. Gout can affect any joint in an asymmetric distribution. Gouty attacks may be isolated or can be followed by years of recurrent flares. Over time, elevated serum urate levels and tophaceous deposits can lead to deformity and disability from underlying bony erosion. The concept of ‘treatment-failure gout’ describes a unique population that has been either unable to tolerate allopurinol or who have not experienced normalization of serum urate levels on allopurinol. It is estimated that approximately 1–1.5% of the estimated 3–8 million people with gout in the USA have treatment-failure gout. Pegloticase is an US FDA-approved intravenous medication that is a mammalian recombinant uricase conjugated to monomethoxy polyethylene glycol. Two recent Phase III trials have found pegloticase to be effective in the management of treatment-failure gout. These studies also highlight safety concerns regarding the drug’s immunogenicity.

Keywords::

• allantoin
• gout
• hyperuricemia
• recombinant uricase
• refractory chronic gout
• treatment-failure gout
• urate-lowering agent
• uricase

Financial & competing interests disclosure

E Krishnan is a consultant for URL Pharma, Inc. (PA, USA) and has received support from Takeda Pharmaceuticals International, Inc. (IL, USA). In the past, he has held stock in Savient Pharmaceuticals, Inc. (NJ, USA). He has served as an advisor/consultant for both of these companies. In addition, he serves as an investigator in clinical trials sponsored by Ardea Biosciences, Inc. (CA, USA) and Metabolex, Inc. (CA, USA). 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.

No writing assistance was utilized in the production of this manuscript.

Notes

Adapted with permission from [30].