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Therapeutic perspectives on uricases for gout
Ricardo P Garay1, M Raafat El-Gewely, Jean-Pierre Labaune
1Inserm U999, hôpital Marie-Lannelongue, université Paris-Sud, 92350 Le-Plessis-Robinson, France. ricardo.garay@orange.fr
Joint Bone Spine
|February 28, 2012
Summary
Recombinant uricases like rasburicase and pegloticase can lower uric acid in gout patients, but long-term use is limited by side effects and immune reactions. Further research is needed for safer, effective gout treatments.
Area of Science:
- Rheumatology
- Pharmacology
- Biochemistry
Background:
- Recombinant uricases are potent hypouricemic agents for tophaceous gout.
- Long-term efficacy and safety of available uricases (rasburicase, pegloticase) remain a concern.
Purpose of the Study:
- To review the literature on recombinant uricases for gout treatment.
- To evaluate the efficacy and limitations of rasburicase and pegloticase in managing gout and tophi.
Main Methods:
- Literature review using Scirus, PubMed, and Science Direct.
- Consultation of drug regulatory authority records and patents.
- Analysis of clinical studies and case reports on uricase therapy for gout.
Main Results:
- Rasburicase showed potential for tophi reduction when infused over months, but gout attacks and hypersensitivity were issues.
- Pegloticase achieved serum uric acid reduction in 40% of chronic gout patients, but non-responders developed antibodies and infusion reactions.
- Development of less immunogenic uricases is crucial for improved gout management.
Conclusions:
- Recombinant uricases may play a role in treating severe, tophaceous gout, potentially as a short-term, first-line therapy for rapid tophi dissolution.
- Addressing immunogenicity and side effects is key to optimizing uricase therapy for gout.
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