Pegloticase is a medication for the treatment of severe, treatment-refractory, chronic gout.
Trade name Krystexxa is a medication for the treatment of severe, treatment-refractory, chronic gout.
It is a third line treatment in those in whom other treatments are not tolerated.
A recombinant uricase conjugated to ethylene glycol.
Intravenous pegloticase rapidly degrades urate.
The drug is administered by infusion intravenously every two weeks.
Elimination half-life 10–12 days
Dose related uric acid reduction in refractory gout lasting several weeks after each IV infusion.
In patient’s with chronic gout, hyperuricemia, allopurinol intolerance or refractoriness, the use of 8 mg of pegloticase every 2 or every 4 weeks for 6 months results in lowered uric acid levels compared to placebo (Sundy JS et al).
Associated with sustained uric acid reductions and significant clinical improvements in substantial proportion of patients with chronic gout and refractoriness to, or intolerance of conventional urate lowering therapy.
Two clinical trials found it lowered uric acid levels and reduced deposits of uric acid crystals in joints and soft tissue.
It is an option for the 3% of people with gout who are intolerant to other medications.
It reduces uric acid levels in this population.
It is likely useful for tophi.
About 40% of people develop resistance to the medication over time.
It is contraindicated with glucose-6-phosphate dehydrogenase deficiency: precipitates a severe, life-threatening hemolysis with methemoglobinemia
Pegloticase is a recombinant porcine-like uricase.
Like rasburicase, it metabolizes uric acid to allantoin, reducing the risk of precipitates.
Allantoin is five to ten times more soluble than uric acid.
In contrast to rasburicase, pegloticase is pegylated to increase its elimination half-life from about eight hours to ten or twelve days.
Pegloticase decreases the immunogenicity of the foreign uricase protein, allowing for an application just once every two to four weeks, making this drug suitable for long-term treatment.