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      New advances in the treatment of gout: review of pegloticase

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          Abstract

          Treatment-failure gout (TFG) affects approximately 50,000 patients or about 1% of the overall population of patients with gout in the United States of America. The severity of TFG is manifested by frequent acute attacks of disabling arthritis, chronic deforming joint disease, destructive masses of urate crystals (tophi), progressive physical disability, and poor health-related quality of life. Pegloticase (Krystexxa ®; Savient Pharmaceuticals, Inc), a novel PEGylated urate oxidase (uricase) enzyme, has been resubmitted for US Food and Drug Administration approval. In a 6-month, placebo-controlled clinical trial, 8 mg of pegloticase for every 2 weeks induced a lytic decrease of serum urate (sUr) concentrations, leading to dissolution of tophi in 40% of patients at final visit. However, 58% were nonresponders to the defined target sUr of 0.36 mmol/L (80% were nonresponders during months 3 and 6), possibly due to anti-body formation. Also, 26%–31% experienced infusion reactions (IRs) and 77% suffered from gout flares. Although long-term data are awaited, an anti-inflammatory strategy, eg, based on glucocorticosteroids, is needed to prevent pegloticase antibody formation leading to IRs and diminished or shortened efficacy, and might also prevent gout flares. According to the current clinical data, pegloticase might have an important role as a (bridging) treatment in sUr-responsive patients for tophi clearance in severe chronic refractory gout.

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          Author and article information

          Journal
          Ther Clin Risk Manag
          Therapeutics and Clinical Risk Management
          Therapeutics and Clinical Risk Management
          Dove Medical Press
          1176-6336
          1178-203X
          2010
          2010
          27 October 2010
          : 6
          : 543-550
          Affiliations
          [1 ] Clinical Pharmacy, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands
          [2 ] Department of Rheumatology, University Medical Centre St. Radboud, Nijmegen, The Netherlands
          Author notes
          Correspondence: MK Reinders, Atrium Medisch Centrum Parkstad, Henri Dunantstraat 5, 6941, PC Heerlen, The Netherlands, Tel +3145 576 7419, Fax +3145 576 7279, Email m.reinders@ 123456atriummc.nl
          Article
          tcrm-6-543
          10.2147/TCRM.S6043
          2988614
          21127695
          © 2010 Reinders and Jansen, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Review

          Medicine

          pharmacotherapy, gout, pegloticase, peg-uricase, hyperuricemia

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