Pegloticase Retreatment Effective for Gout After Gap in Therapy

Pegloticase is indicated for chronic gout in adult patients refractory to conventional therapy
Pegloticase is indicated for chronic gout in adult patients refractory to conventional therapy

According to a recently published case series, retreating with pegloticase following a gap in therapy is both effective and well tolerated in patients with chronic gout who have been successfully treated previously.      

The study authors retrospectively analyzed the charts of 4 chronic gout patients from a practice-based rheumatology clinic. The 4 male patients were 70–75 years old, had been successfully managed with pegloticase in the past, and were retreated with the medication following a >4-week gap in treatment. The study authors explained that the patients had received allopurinol or febuxostat prior to initiating pegloticase, however, remained symptomatic (visible tophi and serum uric acid levels [SUA] of 5.2–10.2mg/dL) despite receiving these agents.

Initial pegloticase treatment involved 8mg infusions administered every 2 weeks for 22 to 124 weeks. Although tophi resolved and SUA levels improved to <1.5mg/dL during initial pegloticase therapy, the medication was discontinued in these patients due to symptom resolution, poor medication adherence, or for other personal reasons.

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The study authors explained, “Following treatment gaps (12–156 weeks), symptoms and SUA levels increased and patients were retreated with pegloticase (4–147 weeks).” They added, “In three of four patients, reinitiating pegloticase lowered SUA levels to below 1.0mg/dL (less than 59μmol/L) and resolved symptoms.” It was also reported that one patient experienced an infusion reaction, which led to the discontinuation of pegloticase. The three other patients did not experience any adverse events or gout flares.

For patients with chronic gout who previously responded to pegloticase therapy, retreatment following a gap in therapy appears to be both effective as well as well-tolerated.

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