Pegloticase (Recombinant PEGylated Uricase — Refractory Gout)

How it works

It is a pegylated recombinant uricase enzyme that catalyses the oxidation of uric acid to allantoin, a more soluble and readily excreted compound, thereby rapidly lowering serum urate.

Prescribing in practice

• Anaphylaxis and infusion reactions can occur, so it must be given under specialist supervision with premedication and resuscitation facilities, and discontinued if serum urate rises persistently as this signals loss of response and increased reaction risk.
• It is contraindicated in glucose-6-phosphate dehydrogenase (G6PD) deficiency owing to the risk of haemolysis and methaemoglobinaemia, so screen high-risk patients beforehand.
• Gout flares are common when treatment begins, so anti-inflammatory flare prophylaxis is recommended.

Monitoring

Monitor serum urate before each infusion to detect loss of response and observe closely for infusion and hypersensitivity reactions.

Counselling the patient

• You may experience a gout flare early in treatment; this does not mean the medicine is not working.
• Report any rash, swelling, chest tightness or breathlessness during or after the infusion immediately.

Evidence & guidelines

Use is supported by the Summary of Product Characteristics and randomised controlled trials in chronic refractory gout.