Concomitant Use of Krystexxa and Other Urate Lowering Drugs Not Advised for Gout

The American College of Rheumatology published an issue of Hotline on January 18, 2012 over concerns regarding concomitant use of Krystexxa (pegloticase) and urate-lowering drugs, such as allopurinol and Uloric (febuxostat), in gout patients. Krystexxa was FDA approved for the treatment of chronic gout refractory to conventional treatment. During clinical trials, it was determined that antibodies to Krystexxa were common in patients treated with the drug. It was also noted that high titer antibody (i.e., high levels of the antibody) were linked to loss of response to Krystexxa and an increased risk of infusion reactions, including anaphylaxis.

In December 2011, the manufacturer of Krystexxa sent a letter to advise healthcare providers against concomitant use of Krystexxa and other urate-lowering drugs. Although Krystexxa was used in clinical trials as monotherapy (the only drug given), post-marketing surveillance revealed the issue of concomitant use in clinical practice. It is recommended that gout patients who are successfully treated with conventional urate lowering drugs should stick with those before considering Krystexxa. Also, urate lowering drugs should be discontinued before using Krystexxa and should not be re-started while Krystexxa is being used. Krystexxa should be used with caution in patients with congestive heart failure. Patients who have G6PD deficiency should not use Krystexxa.

Obtaining a routine serum urate level a few days before an infusion of Krystexxa can help identify patients who may be losing their response to the drug and who may be at risk for an infusion reaction. If pre-treatment serum urate is greater than 6 mg/dl, your doctor may suggest discontinuing Krystexxa.

Related Articles:

• Krystexxa - What You Should Know
• Allopurinol - Chronic Gout Treatment
• Uloric - What You Need to Know
• What Is Hyperuricemia?
• All About Gout

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