From the Guidelines
Alternative preventive regimens for gout include febuxostat, a xanthine oxidase inhibitor, which can be initiated at a dose of 40mg daily and increased to 80mg daily if necessary 1. Additionally, uricosuric agents such as probenecid, 250-500mg twice daily, or lesinurad, 200mg daily, can be used to reduce serum urate levels 1. In cases where these options are contraindicated or not tolerated, pegloticase, a recombinant uricase enzyme, can be administered via intravenous infusion at a dose of 8mg every 2 weeks 1.
- Key considerations for these alternative regimens include:
- Monitoring serum urate levels to ensure target levels are achieved
- Adjusting doses based on renal function and other comorbidities
- Considering patient education and lifestyle modifications to reduce urate levels
- Evaluating the risk of adverse events, such as hypersensitivity reactions and urolithiasis, with certain medications 1
- Important notes:
- Febuxostat has been shown to be more effective than allopurinol in reducing serum urate levels in some studies 1
- Uricosuric agents may be contraindicated in patients with certain renal impairments or urolithiasis 1
- Pegloticase is typically reserved for patients with refractory gout who have failed other treatments 1
From the FDA Drug Label
Patients who completed the randomized clinical trials were eligible to enroll in a 2-year open label extension study Entry criteria for patients to be eligible for the trials were: baseline serum uric acid (SUA) of at least 8 mg/dL; had symptomatic gout with at least 3 gout flares in the previous 18 months or at least 1 gout tophus or gouty arthritis; and had a self-reported medical contraindication to allopurinol or medical history of failure to normalize uric acid (to less than 6 mg/dL) with at least 3 months of allopurinol treatment at the maximum medically appropriate dose.
Alternative preventive regimens for gout besides Allopurinol (Zyloprim) include:
- Pegloticase (KRYSTEXXA) 8 mg every 2 weeks
- Pegloticase (KRYSTEXXA) 8 mg every 4 weeks These regimens are for patients with chronic gout refractory to conventional therapy, and have been shown to be effective in lowering uric acid levels and reducing tophi in clinical trials 2, 2.
From the Research
Alternative Preventive Regimens for Gout
Besides Allopurinol (Zyloprim), there are several alternative preventive regimens for gout, including:
- Febuxostat, a nonpurine selective inhibitor of xanthine oxidase, which has been shown to be effective in lowering serum urate levels and reducing gout flares 3, 4, 5
- Lesinurad, a uric acid reabsorption inhibitor, which can be used as an add-on option to xanthine oxidase inhibitors such as febuxostat or allopurinol 6
- Benzbromarone, a uricosuric agent, which can be used in combination with febuxostat to achieve superior urate lowering in patients with combined-type hyperuricemia 7
Key Findings
- Febuxostat has been shown to be more effective than allopurinol in lowering serum urate levels and reducing gout flares 4
- Lesinurad can be used in combination with allopurinol or febuxostat to achieve serum urate targets 6
- Benzbromarone add-on to low-dose febuxostat has been shown to be superior to febuxostat monotherapy in achieving serum urate targets in patients with combined-type hyperuricemia 7