Table 3. Summary of Recommendations for Case Scenarios of
Refractory Disease in Gout, Including Combination Oral
ULT and Use of Pegloticase
Attempt upward dose titration of a single XOI to respective maximum appropriate
dose. (A)
Febuxostat can be substituted for allopurinol or vice versa in the event of drug
intolerance and adverse events, or initial failure of upward dose titration of a single
XOI.
a
(C)
Consider adding a uricosuric agent (e.g., probenecid, fenofibrate, or losartan) to an XOI
drug (B) or adding a XOI to a uricosuric. (C)
Pegloticase is appropriate for patients with severe gout disease burden and refractoriness
to, or intolerance of, conventional and appropriately dosed ULT.
b
(A)
Pegloticase therapy is NOT recommended as a first-line ULT agent.
ere is insufficient data or expert opinion to recommend duration of pegloticase
treatment.
a
Important drug label information includes that febuxostat and allopurinol should not be used in
combination with each other.
b
Important drug label information includes that pharmacologic oral ULT agents should be discontinued
during the course of pegloticase therapy to avoid masking the loss of a pegloticase serum urate-lowering
effect associated with an increased risk of pegloticase infusion reactions.
