Pegloticase is successfully being used to treat uncontrolled gout in patients on dialysis, according to real-world data presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings. The study, which is the first to document pegloticase use in patients undergoing dialysis, showed that use of the injectable drug is associated with a reduction in erythropoiesis-stimulating agent (ESA) requirements.
The drug is approved for treating refractory or uncontrolled gout, but phase 3 pegloticase clinical trials excluded patients who were dialysis dependent.
Using the US Renal Data System database, Anthony J. Bleyer, MD, of Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues studied 42 patients on dialysis (32 on hemodialysis and 10 on peritoneal dialysis) who were prescribed pegloticase for gout treatment. The median dialysis duration was 31.9 months. The mean interval between pegloticase doses was 14 days. The mean dose was 9.7 mg. Nine patients received at least 12 infusions.
Prior to pegloticase initiation, 90% of patients received ESAs; after initiation, 88% received ESAs. Pegloticase therapy was significantly associated with a decrease in monthly dosing of erythropoiesis-stimulating agents: from a mean 55,314 units before to a mean 37,290 units after pegloticase treatment. Mean hemoglobin levels prior to and after pegloticase use were stable at 10.9 and 10.4 g/dL, respectively.
“The biggest drawback with pegloticase usage has been the need to discontinue therapy due to allergic reactions,” Dr Bleyer told Renal & Urology News. “Thus, the ability to use this medication chronically likely speaks to its efficacy. We believe that hemodialysis patients no longer need to suffer from chronic painful gout attacks, and that gouty tophi can be resolved with this therapy.”
Disclosures: Some investigators are employees of and hold stock in Horizon Therapeutics, which markets pegloticase.
Bleyer AJ, Zhang Y, Kshirsagar O, Marder B, LaMoreaux B. Pegloticase therapy in gout patients undergoing dialysis: A USRDS database study. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10. Poster 183.