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Methotrexate plus pegloticase shows potential for uncontrolled gout

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More patients with uncontrolled gout treated concomitantly with methotrexate and pegloticase maintained therapeutic response at 6 months compared with those receiving pegloticase alone, according to a study published in The Journal of Rheumatology.

In this multicenter, open-label, efficacy and safety study, 14 patients with uncontrolled gout were administered oral methotrexate (15 mg/week) and folic acid (1 mg/day) 4 weeks prior to and throughout treatment with pegloticase. Responders were defined as sUA <6 mg/dL for ≥80% of the time during month 6.

Overall, mean sUA on Day 1 was 9.2 ± 2.5 mg/dL, with 12 patients having visible tophi. At 6 months, 78.6% of patients met responder criteria. Treatment was discontinued in 3 patents after meeting protocol-defined treatment discontinuation rules (pre-infusion sUA values greater than 6 mg/dL at 2 consecutive scheduled visits).

Methotrexate was tolerated and no safety concerns were identified.

The authors note that the therapeutic response at 6 months for patients using pegloticase alone has been reported at 42%.

Further studies are needed to validate these findings.

Botson JK, Tesser JRP, Bennett R, et al. Pegloticase in combination with methotrexate in patients with uncontrolled gout: A multicenter, open-label study (MIRROR). J Rheumatol. 2020; jrheum.200460; DOI: https://doi.org/10.3899/jrheum.200460.