Uricases: reflections on recent developments in the management of challenging gout patients
Oral urate-lowering therapy (ULT) is key to treating gout. However, many patients receiving oral ULT do not achieve the target serum urate (SU) levels, partly because some patients cannot tolerate or have contraindications to their use, mainly due to comorbidities. This may lead to uncontrolled gout...
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Open Exploration Publishing Inc.
2024-10-01
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| Series: | Exploration of Musculoskeletal Diseases |
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| Online Access: | https://www.explorationpub.com/uploads/Article/A100770/100770.pdf |
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| author | Naomi Schlesinger Dan Kaufmann |
| author_facet | Naomi Schlesinger Dan Kaufmann |
| author_sort | Naomi Schlesinger |
| collection | DOAJ |
| description | Oral urate-lowering therapy (ULT) is key to treating gout. However, many patients receiving oral ULT do not achieve the target serum urate (SU) levels, partly because some patients cannot tolerate or have contraindications to their use, mainly due to comorbidities. This may lead to uncontrolled gout. In species other than humans and some non-human primates, uricase (urate oxidase) converts urate to allantoin, which is more readily excreted by the kidney. Exogenous uricases, considered “enzyme replacement therapy”, are a therapeutic option for patients with refractory or uncontrolled gout. Current uricases on the market include pegloticase and rasburicase. Uricase treatment rapidly reduces hyperuricemia and tophaceous deposits and improves the quality of life. This review discusses currently approved uricases on the market and some in development; how best to minimize flares, anti-drug antibody (ADA) formation, infusion reactions, and loss of efficacy, and combination with immunomodulation in patients with gout requiring uricase therapy. |
| format | Article |
| id | doaj-art-e266ae985a7b4a5bb6e345c5c56d39ad |
| institution | DOAJ |
| issn | 2836-6468 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Open Exploration Publishing Inc. |
| record_format | Article |
| series | Exploration of Musculoskeletal Diseases |
| spelling | doaj-art-e266ae985a7b4a5bb6e345c5c56d39ad2025-08-20T03:09:08ZengOpen Exploration Publishing Inc.Exploration of Musculoskeletal Diseases2836-64682024-10-012646147210.37349/emd.2024.00070Uricases: reflections on recent developments in the management of challenging gout patientsNaomi Schlesinger0https://orcid.org/0000-0002-1558-1202Dan Kaufmann1https://orcid.org/0000-0001-9836-1370Division of Rheumatology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84132, USADivision of Rheumatology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84132, USAOral urate-lowering therapy (ULT) is key to treating gout. However, many patients receiving oral ULT do not achieve the target serum urate (SU) levels, partly because some patients cannot tolerate or have contraindications to their use, mainly due to comorbidities. This may lead to uncontrolled gout. In species other than humans and some non-human primates, uricase (urate oxidase) converts urate to allantoin, which is more readily excreted by the kidney. Exogenous uricases, considered “enzyme replacement therapy”, are a therapeutic option for patients with refractory or uncontrolled gout. Current uricases on the market include pegloticase and rasburicase. Uricase treatment rapidly reduces hyperuricemia and tophaceous deposits and improves the quality of life. This review discusses currently approved uricases on the market and some in development; how best to minimize flares, anti-drug antibody (ADA) formation, infusion reactions, and loss of efficacy, and combination with immunomodulation in patients with gout requiring uricase therapy.https://www.explorationpub.com/uploads/Article/A100770/100770.pdfgouturicaseanti-drug antibodiesinfusion reactionsflares |
| spellingShingle | Naomi Schlesinger Dan Kaufmann Uricases: reflections on recent developments in the management of challenging gout patients Exploration of Musculoskeletal Diseases gout uricase anti-drug antibodies infusion reactions flares |
| title | Uricases: reflections on recent developments in the management of challenging gout patients |
| title_full | Uricases: reflections on recent developments in the management of challenging gout patients |
| title_fullStr | Uricases: reflections on recent developments in the management of challenging gout patients |
| title_full_unstemmed | Uricases: reflections on recent developments in the management of challenging gout patients |
| title_short | Uricases: reflections on recent developments in the management of challenging gout patients |
| title_sort | uricases reflections on recent developments in the management of challenging gout patients |
| topic | gout uricase anti-drug antibodies infusion reactions flares |
| url | https://www.explorationpub.com/uploads/Article/A100770/100770.pdf |
| work_keys_str_mv | AT naomischlesinger uricasesreflectionsonrecentdevelopmentsinthemanagementofchallenginggoutpatients AT dankaufmann uricasesreflectionsonrecentdevelopmentsinthemanagementofchallenginggoutpatients |