Adding lesinurad to allopurinol improves uric acid lowering in patients with gout, according to a new study.

Lesinurad is a novel selective uric acid reabsorption inhibitor for the treatment of gout in combination with xanthine oxidase inhibitors. In a randomized phase 3 trial of 603 gout suffers, Kenneth G. Saag, MD, MSc, of the University of Alabama at Birmingham, and collaborators found that the combination of both drugs was significantly more effective at bring patients to a target serum uric acid level of less than 6 mg/dL. Investigators randomly assigned patients to receive allopurinol alone or allopurinol plus lesinurad at a dose of either 200 or 400 mg. The study’s primary outcome was the proportions of patients achieving a serum uric acid level below 6 mg/dL.

At baseline, the study participants, who had a mean age of 51.9 years and gout duration of 11.8 years, had baseline serum uric levels of 6.94 mg/dL. Higher proportions of patients who received lesinurad 200 mg or 400 mg in addition to allopurinol achieved target serum uric acid levels compared with those who received allopurinol alone (54.2%, 59.2%, and 27.9%, respectively), Dr Saag’s group reported online ahead of print in Arthritis & Rheumatology. The combination treatment was not superior to allopurinol alone with regard to rates of gout flares and complete tophus resolution.

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Lesinurad was generally well-tolerated, according to the investigators. The safety profile of the 200-mg dose was similar to that of allopurinol alone, except for higher incidences of mostly reversible serum creatinine elevation.

Combination therapy with lesinurad and allopurinol may represent a treatment option for patients with gout who are unable to achieve target serum uric acid levels on a xanthine oxidase inhibitor alone and warrant additional therapy, Dr Saag and his colleagues concluded.

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1. Saag KG, Fitz-Patrick D, Kopicko J, et al. Lesinurad Combined With Allopurinol: Randomized, Double-Blind, Placebo-Controlled Study in Gout Subjects With Inadequate Response to Standard of Care Allopurinol (A US-based Study). Arthritis Rheumatol. doi: 10.1002/art.39840.