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November 9, 2011

Pegloticase and Chronic Gout

Author Affiliations

Author Affiliations: University Paris Diderot, Sorbonne Paris Cité, Paris, France (Drs Ea and Lioté) (korngea@yahoo.fr); and Université de Rennes, Rennes, France (Dr Chales).

JAMA. 2011;306(18):1979-1980. doi:10.1001/jama.2011.1616

To the Editor: Dr Sundy and colleagues described the effect of pegloticase for treating chronic gout in patients refractory to allopurinol.1 Although pegloticase lowered serum uric acid level, reduced tophi, and increased patient quality of life, we have concerns about its safety and would like to discuss some cautions.

Of the pegloticase-treated patients, 26% to 42% experienced infusion-related reactions (IRs), although they were treated with antihistamines and intravenous corticosteroids prior to each biweekly or monthly infusion over the 6 months of the study. Overall, 6.5% of these IRs were considered to be anaphylaxis, implying that corticosteroid prophylaxis has to be used with each pegloticase infusion. How can the adverse effects of long-term steroid administration in patients with gout be balanced with the benefits?