{"title":"Updates in uricase therapy for gout.","authors":"Naomi Schlesinger, Dan Kaufmann","doi":"10.1097/BOR.0000000000001122","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>Urate-lowering therapy (ULT) plays a pivotal role in treating gout patients. Unfortunately, some patients receiving oral ULT fail to achieve the target serum urate levels of < 6.8 mg/dl, the solubility level of uric acid. Exogenous uricases, considered \"enzyme replacement therapy,\" are a therapeutic option for patients with uncontrolled gout in whom oral ULT has not been efficacious, is not tolerated, or is contraindicated, in some due to underlying comorbidities. Currently, two uricases are available: pegloticase and rasburicase. Pegloticase is indicated for treating uncontrolled gout, while rasburicase is used to prevent tumor lysis syndrome.</p><p><strong>Recent findings: </strong>The main limitations of pegloticase include gout flares and infusion reactions, which are linked to the formation of antidrug antibodies. Immunomodulation and anti-inflammatory prophylaxis can help reduce these issues. New PEGylated uricases, including nanoencapsulated sirolimus combined with pegadricase (NASP) and PRX-115, are being developed and may offer improved options.</p><p><strong>Summary: </strong>Exogenous uricases available and those under development are discussed, focusing on immunomodulation and anti-inflammatory prophylaxis to reduce flares, prevent antidrug antibody formation and infusion reactions, and mitigate loss of efficacy in patients with uncontrolled gout needing uricase replacement therapy.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"422-429"},"PeriodicalIF":4.3000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current opinion in rheumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOR.0000000000001122","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of review: Urate-lowering therapy (ULT) plays a pivotal role in treating gout patients. Unfortunately, some patients receiving oral ULT fail to achieve the target serum urate levels of < 6.8 mg/dl, the solubility level of uric acid. Exogenous uricases, considered "enzyme replacement therapy," are a therapeutic option for patients with uncontrolled gout in whom oral ULT has not been efficacious, is not tolerated, or is contraindicated, in some due to underlying comorbidities. Currently, two uricases are available: pegloticase and rasburicase. Pegloticase is indicated for treating uncontrolled gout, while rasburicase is used to prevent tumor lysis syndrome.
Recent findings: The main limitations of pegloticase include gout flares and infusion reactions, which are linked to the formation of antidrug antibodies. Immunomodulation and anti-inflammatory prophylaxis can help reduce these issues. New PEGylated uricases, including nanoencapsulated sirolimus combined with pegadricase (NASP) and PRX-115, are being developed and may offer improved options.
Summary: Exogenous uricases available and those under development are discussed, focusing on immunomodulation and anti-inflammatory prophylaxis to reduce flares, prevent antidrug antibody formation and infusion reactions, and mitigate loss of efficacy in patients with uncontrolled gout needing uricase replacement therapy.
期刊介绍:
A high impact review journal which boasts an international readership, Current Opinion in Rheumatology offers a broad-based perspective on the most recent and exciting developments within the field of rheumatology. Published bimonthly, each issue features insightful editorials and high quality invited reviews covering two or three key disciplines which include vasculitis syndromes, medical physiology and rheumatic diseases, crystal deposition diseases and rheumatoid arthritis. Each discipline introduces world renowned guest editors to ensure the journal is at the forefront of knowledge development and delivers balanced, expert assessments of advances from the previous year.