Pegloticase

Aka: Pegloticase, Krystexxa

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II. Indications

  1. Gouty Arthritis (chronic, refractory)
    1. Indicated in severe, gout refractory to maximized Uricosurics and lifestyle change
    2. Serum Uric Acid not at target AND continued gout flares >=2/year or tophi

III. Contraindications

  1. Uric Acid >6 mg/dl (esp. if persistently present)
  2. G6PD Deficiency
    1. Hemolysis and Methemoglobinemia risk

IV. Medications

  1. Pegloticase
    1. Very expensive (costs $5000 per dose)

V. Mechanism

  1. Intravenous, pegylated recombinant uric-oxidase enzyme (uricase)
    1. Converts Uric Acid to inactive water soluble form (Allantoin), which is easily excreted

VI. Dosing:

  1. Adult: 8 mg IV infusion over >=120 minutes every 2 weeks
  2. Take NSAIDs or Colchicine concurrently to prevent gout flare
    1. Start 1 week prior to infusion and continue for at least 6 months

VII. Adverse Effects

  1. Anaphylaxis and infusion reactions
    1. Premedicate with Antihistamines and Corticosteroids
    2. Administer in monitored setting prepared for anaphylactic reactions
  2. Hemolysis and Methemoglobinemia risk
    1. Avoid in G6PD Deficiency

VIII. Safety

  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  3. Monitoring
    1. Obtain Uric Acid before dose
      1. Avoid if level >6 mg/dl (esp on repeat dosing)

IX. Resources

  1. Pegloticase (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6e566303-d93a-4130-b764-25749829aa95

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