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Targeted Treatment for Hyperuricemia: The Drug Pipeline.
Austin Barry1,2, Lindsay N Helget3,4, Ted R Mikuls3,4
1Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA. austin.barry@unmc.edu.
Drugs & Aging
|July 1, 2026
Summary
New gout medications are in development, focusing on urate-lowering therapy (ULT) for older adults with multiple health conditions. Emerging treatments show promise for managing gout effectively in this complex patient group.
Area of Science:
- Rheumatology
- Pharmacology
- Geriatrics
Background:
- Gout is a prevalent inflammatory arthritis, disproportionately affecting older adults with comorbidities like chronic kidney disease.
- Comorbidities complicate gout management, including urate-lowering therapy (ULT) and acute flare treatment, often due to polypharmacy.
- Achieving target serum uric acid levels (<6 mg/dL) with existing ULT is challenging for some patients due to intolerance, contraindications, or inadequate response.
Purpose of the Study:
- To review current and emerging pharmacologic therapies for gout, with an emphasis on ULT in clinical development.
- To assess the relevance of these novel gout therapies for aging populations, particularly those with comorbidities.
- To highlight advancements in gout treatment addressing unmet needs in complex patient groups.
Main Methods:
- Narrative review of current and emerging pharmacologic therapies for gout.
- Focus on urate-lowering therapies (ULT) in clinical development, including novel xanthine oxidase inhibitors (XOI) and uricosuric agents.
- Evaluation of novel uricase-based strategies and anti-inflammatory agents targeting NLRP3 inflammasome and IL-1β.
Main Results:
- Novel uricosuric agents like dotinurad show effective urate lowering with good renal and hepatic safety in older adults, including those with chronic kidney disease.
- Emerging uricase-based therapies aim to overcome immunogenicity issues seen with existing treatments.
- Agents targeting NLRP3 inflammasome and IL-1β show potential for gout flare prophylaxis and treatment.
Conclusions:
- Next-generation gout therapies, including URAT1 inhibitors and novel anti-inflammatory agents, are advancing through clinical trials.
- These novel agents may offer improved efficacy and safety profiles, particularly for older adults with comorbidities.
- Further research is needed to ensure the generalizability of clinical trial findings to diverse, real-world gout patient populations.
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