Brad Marder, MD: Pegloticase Therapy in Gout Patients Undergoing Dialysis

This week, Rheumatology Network sat down Brad Marder, MD, co-author of the study, Pegloticase Therapy in Gout Patients Undergoing Dialysis: A USRDS Database Study. Marder is the medical director at Horizon Therapeutics. At the National Kidney Foundation’s Spring Clinical Meeting, which ran from April 6th through the 10th, real-world data on the pegloticase injection, KRYSTEXXA, was shared. Data suggests that pegloticase is successful in the treatment of dialysis patients with uncontrolled gout with potentially lower ESA dose requirements after treatment.

Rheumatology Network: Hi, Dr. Marder, thank you for joining me today.

Brad Marder, MD: It's great to be here. Thanks for inviting me, Lana.

RN: To begin, can you give me a little bit of background on the KRYSTEXXA study?

BM: So yeah, KRYSTEXXA is a medication that's used for uncontrolled gout, which is a quite a common condition in patients with chronic kidney disease. So, we know that the kidney plays a central role in how the body is able to get rid of uric acid. And so, it's not a surprise that these patients with chronic kidney disease have a high prevalence for gout because of their inability to excrete enough through the kidneys. And we also know that gout is actually very difficult to manage in patients with chronic kidney disease due to restrictions on medications that are used to control gout. So, it's not a surprise then that uncontrolled gout is particularly common in these patients with chronic kidney disease. And all that said, it's interesting that we have very little published literature on uncontrolled gout and its treatment in patients who are on dialysis. So, our study sought to shed some light on this subject. And we analyzed the USRDS database between 2012 and 2017. And we identified patients who received KRYSTEXXA for their uncontrolled gout, so that we could help healthcare professionals recognize what kind of individuals these are. And to give them confidence in using KRYSTEXXA to be able to treat this difficult condition. So, our study found that these patients were majority were male. Majority of these patients were actually within the mid-range of age in the age group between 45 and 64. And we also found a high association with comorbidities like diabetes, hypertension, and congestive heart failure. So, all that was very interesting. But the most fascinating thing was in an exploratory analysis, we looked at how much erythropoietin stimulating agents these patients were receiving prior to using KRYSTEXXA to control their uncontrolled gout and then afterward. And we saw that these patients required more erythropoietin stimulating agents prior to the exit treatment than afterward. So, we found that that’s very interesting, because patients tend to need higher doses of these medications when they have diseases that cause systemic inflammation. And that's exactly what's going on. When you have uncontrolled gout, whether you're on dialysis, or whether you're not on dialysis, gout is often seen as this sort of intermittent inflammatory condition of the peripheral joints, but in reality, it's a progressive and systemic disease. Uric acid can deposit just about in any tissue in the body, except for in the central nervous system. And that deposition actually can cause enough systemic inflammation that these patients on dialysis need higher doses of these medications to keep their anemia of chronic kidney disease under control. So, we find this very compelling and interesting. And this is part of a larger study, where we're looking at overall prevalence and medical comorbidities that are associated with gout and these patients that are on dialysis.

RN: Can you tell me a little bit more about the impact of uncontrolled gout in dialysis patients?

BM: So you know, uncontrolled gout is not just a painful condition that can lead to, you know, worse patient reported outcomes, but it's actually quite a disabling condition to many of these patients have a high burden of tophaceous disease that can occur in their feet in their hands, and they can cause significant disability. And so having an agent like KRYSTEXXA to turn to in these difficult to manage case patients can actually be completely life changing in terms of their overall quality of life and their ability to just do day-to-day things like a walk and handle objects normally.

RN: Were there any limitations to your study?

BM: Well, certainly, you know, this was a retrospective study that looks at the USRDS database. And so, there's only so much information that you can get from that. We would be really interested to look at certain blood test levels that are associated with gout, like uric acid levels, but those are not available within that database. But studies like this can be hypothesis generating and give us future directions on what we can study in terms of gout and its management in a more prospective manner.

RN: Is your team planning on doing any further research on the topic?

BM: Oh, we are always doing research. And we're always trying to shed light on this patient population, that that is suffering a great deal with this really debilitating disease. And certainly we're performing studies, not just in patients with chronic kidney disease, but in patients with kidney transplants. And we're also looking to explore more fully how to make KRYSTEXXA more effective and safer to use for all patient populations.

RN: Is there anything that you would like to add on the subject or gout in general before we wrap up?

BM: Well, I just like to say if you have any more questions about uncontrolled gout or the use of KRYSTEXXA, you can find the answers at KRYSTEXXA.com.

RN: Well, thank you so much, Dr. Marder, for speaking with me today. I really appreciate it.

BM: It was really great to be here, Lana. I'm excited to be at the National Kidney Foundation Spring Clinical Meeting. And I'm looking forward to sharing more data with the community just as soon as we're able to report it.