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Background/purpose: Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation.

Methods: We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment.

Results: Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (- 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL.

Conclusion: Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation.

Titel:	Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation.
Autor/in / Beteiligte Person:	Holladay, EE ; Mudano, AS ; Xie, F ; Zhang, J ; Mikuls, TR ; LaMoreaux, B ; Padnick-Silver, L ; Curtis, JR
Link:	Zum Volltext
Zeitschrift:	Arthritis research & therapy, Jg. 26 (2024-04-12), Heft 1, S. 86
Veröffentlichung:	London : BioMed Central, 2003-, 2024
Medientyp:	academicJournal
ISSN:	1478-6362 (electronic)
DOI:	10.1186/s13075-024-03318-5
Schlagwort:	Humans Retrospective Studies Biomarkers Kidney Uric Acid Gout drug therapy Polyethylene Glycols Urate Oxidase
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Arthritis Res Ther] 2024 Apr 12; Vol. 26 (1), pp. 86. <i>Date of Electronic Publication: </i>2024 Apr 12. MeSH Terms: Uric Acid* ; Gout* / drug therapy ; Polyethylene Glycols* ; Urate Oxidase* ; Humans ; Retrospective Studies ; Biomarkers ; Kidney References: FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744–60. (PMID: 10.1002/acr.2418032391934) ; Jansen TL, Tanja G, Matthijs J. A historical journey of searching for uricosuric drugs. Clin Rheumatol. 2022;41(1):297–305. (PMID: 10.1007/s10067-021-05930-134581891) ; Hammam N, Li J, Kay J, Izadi Z, Yazdany J, Schmajuk G. 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(PMID: 10.1177/1759720X18807117) Grant Information: P30 AR072583 United States AR NIAMS NIH HHS; P30AR072583 United States AR NIAMS NIH HHS Contributed Indexing: Keywords: Discontinuation; Gout; Pegloticase; Restart; Treatment gap Substance Nomenclature: 268B43MJ25 (Uric Acid) ; R581OT55EA (Pegloticase) ; 0 (Biomarkers) ; 3WJQ0SDW1A (Polyethylene Glycols) ; EC 1.7.3.3 (Urate Oxidase) Entry Date(s): Date Created: 20240412 Date Completed: 20240415 Latest Revision: 20240426 Update Code: 20240427 PubMed Central ID: PMC11010378

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Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation.