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Community Practice Experiences with a Variety of Immunomodulatory Agents Co-Administered with Pegloticase for the Treatment of Uncontrolled Gout.

Authors :
Broadwell A
Albert JA
Padnick-Silver L
LaMoreaux B
Source :
Rheumatology and therapy [Rheumatol Ther] 2022 Dec; Vol. 9 (6), pp. 1549-1558. Date of Electronic Publication: 2022 Sep 22.
Publication Year :
2022

Abstract

Objective: Patients with uncontrolled/refractory gout have heavy disease burden, but few treatment options. Pegloticase lowers serum urate (SU), but anti-drug antibodies can limit treatment efficacy. Evidence supports immunomodulator-pegloticase co-administration to increase sustained urate-lowering rates, but published cases are limited. This study investigated experience with pegloticase-immunomodulation co-therapy at two community rheumatology practices.<br />Methods: Patients initiating pegloticase with immunomodulation in 2017 or later were included. Patient/treatment characteristics and proportion of responders (≥ 12 pegloticase infusions, SU < 6 mg/dl at infusion-12) were examined. Patients on therapy at data collection with < 12 infusions were excluded from response analyses. eGFR before and after therapy was examined.<br />Results: Thirty-four patients (79% male, 62.4 ± 16.3 years) with uncontrolled gout (SU = 9.1 ± 2.0 mg/dl, 91% tophaceous) were included. Most-reported comorbidities were hypertension (76%), obesity (71%), osteoarthritis (68%), and CKD (47%). Pre-therapy eGFR was 65.4 ± 25.2 ml/min/1.73 m <superscript>2</superscript> (41% eGFR < 60 ml/min/1.73 m <superscript>2</superscript> ). All patients initiated immunomodulation before (5.3 ± 3.0 weeks, n = 32) or at (n = 2) first pegloticase infusion. Subcutaneous methotrexate (15.4 ± 4.9 mg/week, n = 20), oral methotrexate (15.3 ± 3.6 mg/week, n = 9), mycophenolate mofetil (1000 mg/day, n = 3), and azathioprine (100 mg/day, n = 2) were administered. Patients received 14.6 ± 7.1 infusions over 28.5 ± 14.9 weeks. Overall response rate was 89%, ranging among immunomodulators (subcutaneous methotrexate: 93%, oral methotrexate: 89%, mycophenolate mofetil: 100%, azathioprine: 50%). On average, eGFR increased during therapy (+ 10.3 ± 16.9 ml/min/1.73 m <superscript>2</superscript> ), with CKD stability/improvement in 85%. Nineteen patients (56%) experienced gout flares. No infusion reactions or infections were noted. No new safety concerns were identified.<br />Conclusions: These real-world findings provide further support for increased pegloticase response rates when co-treatment with immunomodulating therapy is used.<br /> (© 2022. The Author(s).)

Details

Language :
English
ISSN :
2198-6576
Volume :
9
Issue :
6
Database :
MEDLINE
Journal :
Rheumatology and therapy
Publication Type :
Academic Journal
Accession number :
36136270
Full Text :
https://doi.org/10.1007/s40744-022-00492-3