A New Gout Drug, Pegloticase, Approved by FDA
Gout, as many know, is a very painful arthritic condition involving, in a majority of cases, the joint that joins the big toe to the foot, called the first metatarsophalangeal (MTP) joint.
Later on, it may affect other joints in an ascending manner, though not always. It is due to excessive amount of metabolite called uric acid in the circulation, derived from the metabolism of purine, a type of nuclear protein.
Uric acids are needle shaped crystals that get deposited in the covering membrane of some joints and cause inflammation there, giving rise to painful reddish swelling called gouty tophi. Aspiration of joint material for monosodium urate is confirmatory for the disease. A blood level more than 7.6 mgs% in males and more than 6 mgs% in females is indicative of the disease. But, the disease may be found in a lower blood level of uric acid.
Gout, apart from joints, may affect heart, kidneys and gall bladder in long standing untreated cases. It is associated with diabetes and obesity. Some 3% of affected people do not respond to the conventional drugs like allopurinol and feboxostat. A new drug pegloticase, approved by FDA is an enzyme that acts on the uric acid to degrade it to a harmless chemical that is excreted in urine.
Pegloticase is administered intravenously every two weeks. It gives relief to the majority of non-responders to the conventional drugs. It is not fully safe, as it produces severe allergic reaction in about one fourth of cases during a trial, according to scientists. It may produce gout flare, nausea, injection site bruising, irritation of the nasal passages, constipation, chest pain and vomiting.
Physicians have been warned to be cautious in administering pegloticase to patients with congestive heart failure because the drug was not studied in this patient population. They also have been advised to keep steroid and antihistaminic ready, or to consider prior administration to reduce the allergic reactions.
Rather than using this drug routinely, it is perhaps better to reserve it for non-responders to conventional drugs.
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