OBJECTIVES : To examine treatment for gout following pegloticase discontinuation for patients in US clinical care.

METHODS : Study population: 70 gout-diagnosed patients who initiated their last pegloticase course between Jan 2015 and Dec 2019 with >90 days follow-up from pegloticase discontinuation (index). Statistical analyses included t-test (continuous variables), chi-square or Fischer’s exact tests (categorical variables), and Kaplan-Meier and log-rank test (time to event). Assessments of serum uric acid (sUA) were limited to patients with 2+ measures.

RESULTS : At ≥90 days past pegloticase discontinuation, 49/70 (70%) initiated a uric acid lowering therapy (ULT). Median time from index to ULT was 13 days; 76% (37/49) occurred within 30 days, 90% (44/49) 90 days, and 96% (47/49) 180 days. Median follow up for patients who did not initiate a subsequent ULT was 404 days, greater than but not significantly different from patients that did initiate ULT post-pegloticase (322 days, p=0.270). The absence of kidney disease was significantly associated with ULT initiation within 180 days (39/47, 83% v. 14/23, 61% non-initiators, p=0.043); variables NOT associated included age, gender, race, ethnicity, payer, CVD, diabetes, non-gout rheumatic diseases, duration of prior pegloticase, and sUA ≥6 mg/dL during pegloticase or at pegloticase discontinuation. Of the 47 patients that initiated subsequent ULT within 180 days, 22 of 47 had 2+ sUA measures during treatment, and 9/22 (41%) had 2+ sUA ≥6 mg/dL. Two or more sUA results post-pegloticase were provided for 6/23 patients that did not initiate ULT within 180 days; 5/6 (83%) had 2+ sUA ≥6 mg/dL.

CONCLUSIONS : Consistent sUA <6 ml/dL was not maintained post-pegloticase for half (14/28) of the evaluable patients. As the 2020 ACR Guidelines advises the treat to target approach to maintain sUA <6 ml/dL, our results highlight the need for new ULTs and/or better strategies to maximize benefit with available therapies.