There have been relatively few recent advances in pharmacotherapy for the treatment of gout. Current standard therapy includes the use of corticosteroids, colchicine and NSAIDs for acute flares and primarily allopurinol and probenecid as urate-lowering therapy to prevent gout flares. Uricase (urate oxidase) is an enzyme that converts urate (uric acid) to allantoin, a more water soluble metabolite and therefore more easily excreted by the kidneys.
Rasburicase (Fasturtec®), a recombinant aspergillus-derived version of this enzyme, is used as urate-lowering therapy in the setting of tumour lysis syndrome. However, this agent has a relatively brief biological half-life and is highly immunogenic and is therefore unsuitable as maintenance therapy in chronic gout.
Pegloticase (Krystexxa®) is a novel urate-lowering agent approved in October 2010 by the US FDA for use in treatment-failure gout. It is a modified version of uricase (conjugated with PEG), which significantly increases its active half-life and decreases immunogenicity compared with rasburicase. Pegloticase is administered as an intravenous infusion and given at a dose of 8 mg every two weeks.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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