Brian LaMoreaux, MD: Outcomes Following Discontinuation of Pegloticase Treatment

In an interview with HCPLive, Brian LaMoreaux, MD, senior medical director at Horizon Therapeutics, discussed his study “Evaluation of Outcomes Following Discontinuation of Pegloticase Therapy,” presented at the American College of Rheumatology’s 2023 Convergence in San Diego, California.¹

LaMoreaux and his team utilized the Rheumatology Information System for Effectiveness (RISE) registry, which is a nationwide database where rheumatologists input electronic patient information. This database is particularly significant as it involves over 1000 rheumatologists contributing data. The American College of Rheumatology (ACR) manages this extensive database, enabling analysis of a variety of questions related to rheumatology.

This study, similar to others LaMoreaux and his team have conducted, focused on the aftermath of pegloticase therapy. To thoroughly examine this, they captured data from 375 patients, including uric acid values pre- and post-therapy, along with information on prior urate-lowering treatments. The findings mirrored previous observations, showing many patients transitioned to some form of oral urate-lowering therapy post-pegloticase treatment. However, what surprised their team was 5% of patients, after a 12-week gap, returned to pegloticase and responded well with uric acid levels reaching 0.9 after a repeat course.

Traditionally, pegloticase is viewed as a 1-time treatment spanning around 10 – 11 months. However, challenges with its infusion schedules and monitoring often lead to patient lapses or missed doses. Consequently, a notable portion required retreatment, highlighting the feasibility of readministering pegloticase successfully.

LaMoreaux emphasized clinicians frequently inquire about post-pegloticase strategies. They must focus on patient monitoring and guiding them through an effective pegloticase course followed by transitioning to oral therapies, while assessing if re-treatment is necessary based on their response.

In the future, LaMoreaux and his team are enthusiastic about delving deeper into the RISE database. Upcoming studies will include investigating kidney function trends during pegloticase use and exploring the correlation between markers of inflammation and gout management. Additionally, preliminary observations suggested a potential reduction in inflammation post-pegloticase treatment, indicating the need for further investigation into these trends among patients with uncontrolled gout.

References

1. ^{Holladay E, Mudano AS, Xie F, Zhang J, et al. Evaluation of Outcomes Following Discontinuation of Pegloticase Therapy. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.}