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Gout in 2023

Emerging therapeutic options for refractory gout

Nature Reviews Rheumatology volume 20, pages 73–74 (2024)Cite this article

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For individuals with gout, the treatment options beyond conventional urate-lowering therapies are expanding. Notable advancements in 2023 include developments in uricase therapy, new xanthine oxidase inhibitors, and a class of medications that offer dual benefits for the control of type 2 diabetes mellitus and gout.

Key advances

  • Co-administration of methotrexate or rapamycin-containing nanoparticles enhances the long-term effectiveness of uricase therapy by suppressing the production of anti-drug antibodies3,5.

  • Tigulixostat, a xanthine oxidase inhibitor, has demonstrated high urate-lowering efficacy and a good safety profile compared with placebo, but head-to-head comparison to allopurinol is still required6.

  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide dual benefits as they not only serve as antidiabetic therapies but also reduce serum urate concentrations and the risk of gout flare8,9.

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References

  1. FitzGerald, J. D. et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol. 72, 879–895 (2020).

    Article  PubMed  Google Scholar 

  2. Botson, J. K. et al. A randomized, placebo-controlled study of methotrexate to increase response rates in patients with uncontrolled gout receiving pegloticase: primary efficacy and safety findings. Arthritis Rheumatol. 75, 293–304 (2023).

    Article  CAS  PubMed  Google Scholar 

  3. Botson, J. K. et al. A randomized, double-blind, placebo-controlled multicenter efficacy and safety study of methotrexate to increase response rates in patients with uncontrolled gout receiving pegloticase: 12-month findings. ACR Open Rheumatol. 5, 407–418 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kivitz, A. et al. Phase 2 dose-finding study in patients with gout using SEL-212, a novel PEGylated uricase (SEL-037) combined with tolerogenic nanoparticles (SEL-110). Rheumatol. Ther. 10, 825–847 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baraf, H. S. B. et al. The COMPARE head-to-head, randomised-controlled trial of SEL-212 (pegadricase plus rapamycin-containing nanoparticle, ImmTOR™) versus pegloticase for refractory gout. Rheumatology https://doi.org/10.1093/rheumatology/kead333 (2023).

    Article  PubMed  Google Scholar 

  6. Terkeltaub, R., Lee, J., Min, J., Shin, S. & Saag, K. G. Serum urate-lowering efficacy and safety of tigulixostat in gout patients with hyperuricemia: a randomized, double-blind, placebo-controlled, dose-finding trial. Arthritis Rheumatol. 75, 1275–1284 (2023).

    Article  CAS  PubMed  Google Scholar 

  7. White, W. B. et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N. Engl. J. Med. 378, 1200–1210 (2018).

    Article  CAS  PubMed  Google Scholar 

  8. McCormick, N. et al. Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for recurrent gout flares and gout-primary emergency department visits and hospitalizations : a general population cohort study. Ann. Intern. Med. 176, 1067–1080 (2023).

    Article  PubMed  Google Scholar 

  9. Wei, J. et al. Gout flares and mortality after sodium-glucose cotransporter-2 inhibitor treatment for gout and type 2 diabetes. JAMA Netw. Open. 6, e2330885 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yip, A. S. Y. et al. Effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on serum urate levels in patients with and without diabetes: a systematic review and meta-regression of 43 randomized controlled trials. Ther. Adv. Chronic. Dis. https://doi.org/10.1177/20406223221083509 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

    Kanon Jatuworapruk

  2. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Worawit Louthrenoo

Authors
  1. Kanon Jatuworapruk
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  2. Worawit Louthrenoo
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Correspondence to Worawit Louthrenoo.

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Competing interests

K.J. is a co-investigator in the EURELIA2 study (NCT05586971), sponsored by LG Chem. W.L. declares no competing interests.

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Jatuworapruk, K., Louthrenoo, W. Emerging therapeutic options for refractory gout. Nat Rev Rheumatol 20, 73–74 (2024). https://doi.org/10.1038/s41584-023-01066-5

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