Oral Urate-Lowering Therapy Use and Efficacy Following Pegloticase Treatment: Findings from a Rheumatology Network Database.

Background: Pegloticase rapidly reduces serum urate (SU) in uncontrolled gout. This preliminary retrospective analysis of a large US rheumatology database examined post-pegloticase use and SU-lowering efficacy of oral urate-lowering therapy (ULT; allopurinol, febuxostat, probenecid).

Methods: Patients in the United Rheumatology (UR)-NICE data repository with first pegloticase code (J2507) in 2012-2022 and data for ≥ 60 days following last infusion were included. Post-pegloticase oral ULT efficacy was defined as SU < 6 mg/dL after oral ULT initiation and examined by shorter (< 12 infusions) and longer (≥ 12 infusions) pegloticase course and by time to post-pegloticase oral ULT start.

Results: A total of 211 patients (77.3% male; 62.7 ± 12.8 years, body mass index 32.9 ± 7.2 kg/m2, estimated glomerular filtration rate 66.0 ± 24.7 ml/min/1.73 m2) with gout [74.4% tophaceous, SU 7.9 ± 2.5 mg/dL (n = 148)] were included; 66.8% received pre-pegloticase oral ULT (48.8% allopurinol, 32.2% febuxostat, and/or 12.3% probenecid). Patients received 12.3 ± 12.6 pegloticase infusions [median 9; 88 (42%) ≥ 12 infusions; 2.3 ± 2.0 weeks between infusions], with 115 patients (54.5%) beginning oral ULT after pegloticase discontinuation (67.0% allopurinol, 43.5% febuxostat, and/or 16.5% probenecid) most-often (66.1%) ≤ 30 days of last infusion. More patients who received ≥ 12 infusions than < 12 infusions had SU < 6 mg/dL with post-pegloticase oral ULT use [first post-ULT SU < 6 mg/dL, 78.4% vs. 36.2%; SU 4.7 ± 3.0 (n = 37) vs. 7.4 ± 2.9 (n = 47) mg/dL].

Conclusions: In this uncontrolled gout population, approximately two-thirds of patients began oral ULT within 30 days after their last pegloticase infusion. Those with longer pegloticase course more often had oral ULT efficacy, perhaps because of greater urate burden depletion, suggesting oral ULTs may be effective after successful pegloticase therapy. Further studies to understand any influence of urate burden on oral ULT efficacy are warranted.