Can Lesinurad Added to Allopurinol Lower Serum Urate in Gout Patients?

Adding lesinurad to allopurinol provided extra benefit vs. allopurinol alone in lowering serum urate (sUA) levels and is an option for patients requiring additional urate-lowering, a study published in Arthritis & Rheumatology reported.

Lesinurad, a selective uric acid reabsorption inhibitor, is given in combination with xanthine oxidase inhibitors. CLEAR 1 (Combining Lesinurad with Allopurinol Standard of Care in Inadequate Responders) was a Phase 3, 12-month, randomized trial (n=603) evaluating lesinurad 200mg or 400mg daily added to allopurinol in patients with sUA above the <6.0mg/dL target. Participants were taking allopurinol ≥300mg with sUA ≥6.5mg/dL at screening and had ≥2 gout flares in the past year.  

The study’s primary endpoint was proportion of patients achieving sUA <6.0mg/dL at Month 6. Study authors found that lesinurad 200m and 400mg doses added to allopurinol significantly increased proportions of subjects meeting the sUA target vs. allopurinol alone by Month 6 (54.2% and 59.2% vs. 27.9%, respectively; P<0.0001). Regarding secondary endpoints, lesinurad was not significantly superior in rates of gout flares and complete tophus resolution. 

Lesinurad was well-tolerated with the safety profile of the 200mg daily dose similar to allopurinol alone except for higher incidences of predominantly-reversible serum creatinine elevation. 

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