Tarun Sharma, MD: Advancements in the Treatment, Management of Gout

In an interview with HCPLive Rheumatology, Tarun Sharma, MD, associated with the Allegheny Health Network, discusses the overarching trends in treating gout, predictions for the future, and the stigma that often surrounds a gout diagnosis.

Tarun Sharma, MD

Credit: Allegheny Health Network

What are some of the trends you’ve witnessed in terms of treatment over the past year?

There have been notable trends and advancements over the past year. One of the emerging patterns is the use of Kystexxa, also known as pegloticase, as a therapy for refractory gout. This treatment is utilized when gout does not adequately respond to oral agents for lowering uric acid levels in the blood, which are the standard of care for gout treatment. Pegloticase is an intravenous therapy that effectively melts uric acid crystals and rapidly reduces uric acid levels in the blood.

Recently, the US Food and Drug Administration (FDA) has added the use of methotrexate alongside pegloticase to reduce the burden of antibodies to pegloticase, leading to better tolerability and improved efficacy. The addition of methotrexate has shown promising results in doubling the response to pegloticase.

Another noteworthy development, although not directly related to gout, is the FDA's approval of colchicine as a treatment for atherosclerotic cardiovascular disease. This encourages the more liberal use of colchicine in gout patients, offering them additional benefits beyond gout treatment.

Are there any other current trials or treatment options that you're particularly excited about currently?

Looking ahead, there is hope for newer therapies in the future, possibly similar to pegloticase, such as uricase-based treatments that break down uric acid. These advancements may be particularly beneficial as the prevalence of gout is increasing due to an aging population and comorbidities.

What do you predict for the in the upcoming year in terms of advancements and the treatment and management of this condition?

In the upcoming year, it would be promising to see certain improvements in the standard of care for gout treatment. For instance, implementing a treat-to-target strategy to aggressively bring down uric acid levels, which has been shown to lead to better clinical outcomes. Additionally, nurse or pharmacist-led programs to improve compliance and dosing of uric acid-lowering medications like allopurinol and febuxostat could enhance treatment efficacy.

Although gout is not always avoidable, how can patients with gout can prevent mortality and/or reduce their risk of developing this condition?

Patients can focus on maintaining a healthy lifestyle. This includes making healthy food choices, engaging in regular exercise, managing weight, and addressing comorbidities like metabolic syndrome, diabetes, hypertension, and chronic kidney disease. Reducing these risk factors can contribute to overall cardiovascular health, which is essential for gout patients, as they have an increased risk of cardiovascular events.

What are your thoughts on the stigma that seemingly surrounds a gout diagnosis?

The stigma may be related to historical associations with unhealthy dietary choices and alcohol use. However, it is crucial to dispel these misconceptions and recognize that gout is a common form of inflammatory arthritis that requires proper care and management. It is not merely a condition characterized by occasional flare-ups but can have broader health implications, making it essential for patients to seek appropriate treatment and preventive measures.

Is there anything else you’d like our audience to know?

In summary, ongoing research and advancements in gout treatment offer hope for improved management and better outcomes for patients. By addressing risk factors and seeking timely care, gout patients can effectively manage the condition and its related health risks.

This transcript was edited for clarity.