Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation
Abstract Background/Purpose Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. Methods We conducted a re...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-024-03318-5 |
| _version_ | 1797209239449501696 |
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| author | Emily E. Holladay Amy S. Mudano Fenglong Xie Jingyi Zhang Ted R. Mikuls Brian LaMoreaux Lissa Padnick-Silver Jeffrey R. Curtis |
| author_facet | Emily E. Holladay Amy S. Mudano Fenglong Xie Jingyi Zhang Ted R. Mikuls Brian LaMoreaux Lissa Padnick-Silver Jeffrey R. Curtis |
| author_sort | Emily E. Holladay |
| collection | DOAJ |
| description | Abstract Background/Purpose Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. Methods We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment. Results Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (− 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL. Conclusion Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation. |
| first_indexed | 2024-04-24T09:51:32Z |
| format | Article |
| id | doaj.art-dacf2495b86f436fb4c85b5bbe55702e |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-04-24T09:51:32Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthritis Research & Therapy |
| spelling | doaj.art-dacf2495b86f436fb4c85b5bbe55702e2024-04-14T11:23:47ZengBMCArthritis Research & Therapy1478-63622024-04-0126111110.1186/s13075-024-03318-5Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuationEmily E. Holladay0Amy S. Mudano1Fenglong Xie2Jingyi Zhang3Ted R. Mikuls4Brian LaMoreaux5Lissa Padnick-Silver6Jeffrey R. Curtis7University of Alabama at BirminghamFoundation for Advancing Science, Technology, Education, and ResearchUniversity of Alabama at BirminghamUniversity of Alabama at BirminghamUniversity of Nebraska Medical Center and the VA Nebraska-Western Iowa Health Care SystemHorizon Therapeutics Plc (Now Amgen Inc.)Horizon Therapeutics Plc (Now Amgen Inc.)University of Alabama at BirminghamAbstract Background/Purpose Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. Methods We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment. Results Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (− 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL. Conclusion Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation.https://doi.org/10.1186/s13075-024-03318-5GoutPegloticaseTreatment gapRestartDiscontinuation |
| spellingShingle | Emily E. Holladay Amy S. Mudano Fenglong Xie Jingyi Zhang Ted R. Mikuls Brian LaMoreaux Lissa Padnick-Silver Jeffrey R. Curtis Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation Arthritis Research & Therapy Gout Pegloticase Treatment gap Restart Discontinuation |
| title | Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation |
| title_full | Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation |
| title_fullStr | Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation |
| title_full_unstemmed | Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation |
| title_short | Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation |
| title_sort | urate lowering therapy serum urate inflammatory biomarkers and renal function in patients with gout following pegloticase discontinuation |
| topic | Gout Pegloticase Treatment gap Restart Discontinuation |
| url | https://doi.org/10.1186/s13075-024-03318-5 |
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