Compared with intravenous hydrocortisone, IV methylprednisolone appears to be more beneficial as a pre-infusion prophylaxis therapy in patients receiving pegloticase, according to the findings of a recently published review.

Pegloticase is currently approved by the Food and Drug Administration (FDA) for the treatment of chronic gout in adult patients refractory to conventional therapy. To minimize the risk of anaphylaxis and infusion reactions, it is recommended that patients receive pre-infusion medications, including antihistamines and corticosteroids. While the efficacy of IV hydrocortisone was examined in clinical trials, in clinical practice, clinicians often use methylprednisolone for pre-infusion prophylaxis.

To compare the efficacy of these 2 corticosteroids in preventing pegloticase therapy discontinuation, study authors conducted a retrospective chart review of 92 qualifying patients receiving pegloticase who were administered either IV hydrocortisone or IV methylprednisolone as pre-infusion prophylaxis. Assessments were made based on patient demographics, type and dose of steroid administered, pegloticase therapy duration, the number of infusions administered, as well as the number of infusion reactions (IRs) experienced. 

“When methylprednisolone was used as a pre-infusion prophylaxis instead of hydrocortisone, patients in this retrospective study received a significantly greater number of pegloticase infusions and a significantly smaller proportion experienced IR,” the study authors stated. The average number of pegloticase infusions was reported to be 8.5 for patients pre-treated with methylprednisolone compared with 4.9 for patients who received hydrocortisone (P < .001). Results of the study also found that only 8.2% of methylprednisolone-treated patients discontinued treatment early due to IRs compared with 41.9% of hydrocortisone-treated patients (P < .01). 

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“Higher mean doses of methylprednisolone may have caused a greater immunomodulatory effect than the lower dose equivalent of hydrocortisone, thus attenuating the immunogenicity of pegloticase,” the authors noted, adding that “Immunogenicity involving the development of anti-drug antibodies to pegloticase remains a major risk factor for development of IRs and discontinuation of therapy.”

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