Pegloticase for the Management of Gout

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In the MD Insights program “The ‘Disease of Kings:’ Addressing Misperceptions and Treating Gout Effectively Now and in the Future,” Theodore R. Fields, MD, professor of clinical medicine at Weill-Cornell Medical College, and director of the Rheumatology Faculty Practice Plan at Hospital for Special Surgery, discusses gout diagnosis, misperceptions about the disease, and the consequences of undertreatment of this condition. He also reviews current gout treatment options and discusses potential future treatments.

Fields said pegloticase is an important addition to the armamentarium because there are certain patients with gout for whom treatment with allopurinol, febuxostat, and/or probenecid is insufficient. These patients “either can’t tolerate them, they’re not effective enough, and often these patients will have large tophi, they’ll really be problematic,” he said. Some of the patients have draining tophi that increase their risk of infections.

Although it is good to have pegloticase available as an option, “It’s a tough regimen for them. It’s several hours every two weeks of an intravenous drug and they have to get their blood work done before each treatment,” said Fields.

However, pegloticase is quite effective. “The tophi shrink better with pegloticase than any other agent that we have because this is the one agent where often after you treat them and you test the uric acid it’s undetectable,” said Fields. “The data show that if someone has tophi the lower you get the uric acid the faster they will shrink the tophi. So there are patients that are really appropriate for this agents. So it’s very good that we have it available.”