Retreatment with Pegloticase after a gap effective in Gout

Retreating with pegloticase following a gap in therapy is both effective and well tolerated in patients with chronic gout who have been successfully treated previously, says study.

Gout is a type of arthritis. It occurs when uric acid builds up in blood and causes inflammation in the joints. Acute gout is a painful condition that often affects only one joint. Chronic gout is the repeated episodes of pain and inflammation.

This report describes four patients with chronic gout who were successfully managed with pegloticase and were retreated following a gap in therapy. Patient charts from a practice-based rheumatology clinic were retrospectively analyzed; four male patients, aged 70-75 years, with chronic gout and a more than a 4-week gap in pegloticase therapy were reviewed. Before pegloticase treatment, patients had received allopurinol or febuxostat, but they continued exhibiting symptoms, including visible tophi and serum uric acid (SUA) levels of 5.2-10.2 mg/dL (309-607 μmol/L), despite oral urate-lowering therapy.

The first pegloticase treatment (8-mg infusion every 2 weeks) lasted 22-124 weeks. Pegloticase resolved tophi and improved SUA to below 1.5 mg/dL (less than 89 μmol/L); however, patients discontinued pegloticase because of symptom resolution, poor adherence, or personal reasons.

Following treatment gaps (12-156 weeks), symptoms and SUA levels increased and patients retreated with pegloticase (4-147 weeks). In three of four patients, reinitiating pegloticase lowered SUA levels to below 1.0 mg/dL (less than 59 μmol/L) and resolved symptoms. One patient experienced an infusion reaction and discontinued; no infusion reactions, gout flares, or adverse events occurred among the other three patients.

The researchers explained, “Following treatment gaps (12–156 weeks), symptoms and SUA levels increased and patients retreated with pegloticase (4–147 weeks).” They added, “In three of four patients, reinitiating pegloticase lowered SUA levels to below 1.0mg/dL (less than 59μmol/L) and resolved symptoms.” It was also reported that one patient experienced an infusion reaction, which led to the discontinuation of pegloticase. The three other patients did not experience any adverse events or gout flares.

The study concluded that retreatment with pegloticase in patients with chronic gout after a gap in therapy appears to be an effective and tolerated option in prior responders.