Brian LaMoreaux, MD: Use and Efficacy Post-Pegloticase Treatment

In an interview with HCPLive, Brian LaMoreaux, MD, senior medical director at Horizon Therapeutics, explained the impact of his study “Oral Urate-Lowering Therapy Use and Efficacy Following Pegloticase Treatment: Findings from a Rheumatology Network Database,” presented at the American College of Rheumatology’s 2023 Convergence in San Diego, California.¹

A common question from physicians revolves around what to do after pegloticase treatment, LaMoreaux explained. While there is strong clinical trial data on patient experience and efficacy leading to urate resolution, there is limited guidance post-treatment. The aim of this study was to understand real-world practices among rheumatologists following pegloticase treatment. To achieve this, LaMoreaux and his team used information from a large rheumatology database. They analyzed data from 211 patients with gout who underwent pegloticase treatment, of which most subsequently received oral urate-lowering therapy.

An interesting observation emerged when investigators categorized patients based on receiving more or less than 12 infusions (a 6-month course). Those with >6 months of pegloticase found it easier to maintain uric acid levels below 6 post-treatment. Within this patient population, LaMoreaux stated maintaining uric acid below this level is crucial for preventing symptoms' return. Patients receiving ≥12 infusions and starting oral therapy within 60 days afterward saw most maintain this level. Even patients with 12 infusions who delayed oral therapy still showed over 50% success.

However, those with <12 infusions faced more challenges in keeping uric acid levels controlled, with approximately a third able to achieve the desired levels. This underlines the importance of both the duration of pegloticase treatment and prompt initiation of oral urate-lowering therapy post-treatment for sustained benefits. Thus, it's advisable to provide a minimum of 6 months of pegloticase and monitor uric acid levels closely after cessation. The most successful outcomes were observed in patients with at least 6 months of therapy who promptly began oral therapy within 60 days.

The results of this study created opportunities for further exploration, considering the limitations in dose-specific urate-lowering therapy data post-pegloticase treatment. The crucial aspect, LaMoreaux emphasized, is maintaining uric acid below 6, regardless of the chosen medication. He had his team hope to better understand optimal dosing strategies post-pegloticase.

References

1. ^{Padnick-SilverL, ConcoffA, Gao HY, Fu Q, et al. Oral Urate-Lowering Therapy Use and Efficacy Following Pegloticase Treatment: Findings from a Rheumatology Network Database. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.}