TY - JOUR T1 - Dissociation Between Clinical Benefit and Persistent Urate Lowering in Patients with Chronic Refractory Gout Treated with Pegloticase JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.190161 SP - jrheum.190161 AU - Michael H. Pillinger AU - Theodore Fields AU - Anthony E. Yeo AU - Peter E. Lipsky Y1 - 2019/06/15 UR - http://www.jrheum.org/content/early/2019/06/11/jrheum.190161.abstract N2 - Objective Assess clinical benefit in patients with chronic refractory gout who did not meet the protocol-defined criteria of responders to pegloticase. Methods This analysis used results from two randomized controlled trials (RCTs) to assess the clinical efficacy in responders and nonresponders to treatment (8 mg of pegloticase every 2 weeks [q2w]). Serum urate was measured before each infusion and the following were measured: assessment of gout flares, tophus reduction, Patient Global Assessment (PGA), tender and swollen joints (TJC and SJC), pain measured with a 100-mm visual analog scale (VAS) and a variety of patient reported outcomes (36-Item Short Form Health Survey (SF-36) Physical Component Score [PCS] and Arthritis-Specific Health Index Score [ASHIS]). Results The analysis included 36 persistent urate responders, 49 nonresponders, and 43 patients who received placebo. Results for both responders and nonresponders indicated significant reduction in tophi and improvements from baseline in PGA, TJC, SJC, pain, and ASHIS. No significant improvements were observed in the patients who received placebo. Conclusion Chronic refractory gout patients not achieving protocol-defined persistent urate lowering still achieve significant clinical benefits with pegloticase treatment, suggesting that transient reduction in serum urate may result in sustained clinical benefit. ER -