According to the ACR guidelines, when should changing the ULT strategy be considered in the treatment of gout?

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

When to consider changing ULT strategy:

  • Switching to a second xanthine oxidase inhibitor (XOI) over adding a uricosuric agent is conditionally recommended for patients taking their first XOI, who have persistently high serum urate concentrations (>6 mg/dL) despite maximum tolerated or FDA-indicated XOI dose, and who have continued frequent gout flares (>2 flares/year) or who have nonresolving subcutaneous tophi.
  • Switching to pegloticase over continuing current ULT is strongly recommended for patients with gout for whom XOI treatment, uricosurics, and other interventions have failed to achieve the serum urate target, and who continue to have frequent gout flares (≥2 flares/year) or who have nonresolving subcutaneous tophi.
  • Switching to pegloticase over continuing current ULT is strongly recommended against for patients with gout for whom XOI treatment, uricosurics, and other interventions have failed to achieve the SU target, but who have infrequent gout flares (< 2 flares/year) AND no tophi>< 2 flares/year) and no tophi.

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