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Lesinurad: what the nephrologist should know
Maria Dolores Sanchez-Niño1,2,3, Binbin Zheng-Lin1,2, Lara Valiño-Rivas1,2,3
1Department of Nephrology, IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.
Clinical Kidney Journal
|October 6, 2017
Summary
Lesinurad, an oral URAT1 inhibitor, effectively lowers serum uric acid when combined with xanthine oxidase inhibitors for gout treatment. However, it carries risks of nephrotoxicity and potential cardiovascular events, requiring careful monitoring by nephrologists.
Area of Science:
- Nephrology
- Pharmacology
- Rheumatology
Background:
- Lesinurad is an oral URAT1 inhibitor approved for gout treatment.
- It is used in combination with xanthine oxidase (XO) inhibitors for patients with inadequate serum uric acid control.
- Lesinurad carries risks of nephrotoxicity and potential cardiovascular events.
Purpose of the Study:
- To inform nephrologists about lesinurad's indications and safety profile.
- To review the efficacy and safety of lesinurad in gout management.
- To highlight the risks associated with lesinurad, including nephrotoxicity and cardiovascular events.
Main Methods:
- Review of lesinurad's mechanism of action as a URAT1 inhibitor.
- Analysis of clinical trial data regarding serum uric acid reduction.
- Evaluation of lesinurad's safety profile, including nephrotoxicity and cardiovascular risks.
Main Results:
- Lesinurad combined with XO inhibitors achieved greater serum uric acid reduction compared to XO inhibitors alone.
- A higher proportion of patients reached target serum uric acid levels with the combination therapy.
- Nephrotoxicity (doubled serum creatinine) occurred in 1.8% of lesinurad patients, with 11% experiencing irreversible effects.
Conclusions:
- Lesinurad is an effective add-on therapy for gout patients not achieving target serum uric acid levels with XO inhibitors alone.
- Nephrologists must be aware of lesinurad's nephrotoxicity risk, particularly at the 200mg/day dose.
- Careful patient selection and monitoring are essential due to potential renal and cardiovascular adverse events.
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