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