II. Indications
-
Gouty Arthritis (chronic, refractory)
- Indicated in severe, gout refractory to maximized Uricosurics and lifestyle change
- Serum Uric Acid not at target AND continued gout flares >=2/year or tophi
III. Contraindications
- Uric Acid >6 mg/dl (esp. if persistently present)
-
G6PD Deficiency
- Hemolysis and Methemoglobinemia risk
IV. Medications
- Pegloticase
- Very expensive (costs $5000 per dose)
V. Mechanism
- Intravenous, pegylated recombinant uric-oxidase enzyme (uricase)
- Converts Uric Acid to inactive water soluble form (Allantoin), which is easily excreted
VI. Dosing:
- Adult: 8 mg IV infusion over >=120 minutes every 2 weeks
- Take NSAIDs or Colchicine concurrently to prevent gout flare
- Start 1 week prior to infusion and continue for at least 6 months
VII. Adverse Effects
-
Anaphylaxis and infusion reactions
- Premedicate with Antihistamines and Corticosteroids
- Administer in monitored setting prepared for anaphylactic reactions
-
Hemolysis and Methemoglobinemia risk
- Avoid in G6PD Deficiency
VIII. Safety
IX. Resources
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Amino Acid, Peptide, or Protein (T116) , Enzyme (T126) , Pharmacologic Substance (T121) |
MSH | C031545 |
SnomedCT | 449280003 |
English | PEG-uricase, PEGLOTICASE, pegloticase, Pegloticase (substance), Methoxypolyethylene Glycol Uricase, Oxidase, Urate (Synthetic Sus scrofa variant pigks-DN subunit), homotetramer, amide with alpha-carboxy-omega-methoxypoly(oxy-1,2-ethanediyl), Polyethylene Glycol-uricase, Des-(1-6)-(7-threonine,46-threonine,291-lysine,301-serine)uricase (EC 1.7.3.3, urate oxidase) Sus scrofa (pig) tetramer, Non Acetylated, Carbamates with alpha-carboxy-omega-methoxypoly(oxyethylene), Pegloticase, polyethylene glycol-uricase, methoxypolyethylene glycol uricase |
Spanish | pegloticasa (sustancia), pegloticasa |