How is nonrecombinant urate-oxidase (uricase) used in the treatment of chronic gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Nonrecombinant urate-oxidase (uricase) is used in Europe to prevent severe hyperuricemia induced by chemotherapy in patients with malignancies, as well as in selected patients with treatment-refractory gout. Short-term use of such agents in patients with severe tophaceous gout could debulk the total-body urate load, allowing maintenance with probenecid or allopurinol.

In 2009, the FDA approved recombinant uricase (rasburicase) for the prevention of tumor lysis syndrome. However, it is highly immunogenic and may cause anaphylaxis. [178]

In 2010, a polyethylene-glycol–conjugated uricase (pegloticase) was approved by the FDA for gout. Pegloticase, which enzymatically catalyzes the oxidation of uric acid to allantoin, is an IV biologic agent to be considered when adjustment of contributing medications (eg, diuretics) and treatment with allopurinol, febuxostat, and uricosuric agents are insufficient to achieve appropriate reduction of serum uric acid levels. [125] The European Medicines Agency (EMA) has approved use of pegloticase in Europe. [179]


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