Pegloticase (Krystexxa) is a specialized biologic medication for severe, treatment-resistant gout that rapidly lowers uric acid levels and can dissolve tophi when other treatments have failed.
Pegloticase is a recombinant, PEGylated uricase enzyme that converts uric acid into a more soluble compound called allantoin, which is easily eliminated by the kidneys.
Unlike humans, most mammals naturally produce uricase, which helps them maintain lower uric acid levels. Pegloticase essentially provides this missing enzyme, allowing for rapid and dramatic lowering of uric acid levels, even in patients with extensive crystal deposits or tophi.
Pegloticase requires a different approach than oral gout medications:
Many rheumatologists now combine pegloticase with immunomodulatory drugs like methotrexate to reduce the development of antibodies against pegloticase, which can make it less effective over time.
Pegloticase has significant potential side effects that require careful monitoring:
Important Warning:
Pegloticase can cause serious allergic reactions (anaphylaxis) during or after the infusion. This risk increases if you continue treatment after developing high uric acid levels. Always have your uric acid levels tested prior to each infusion.
For patients who can tolerate it, pegloticase can provide dramatic benefits for severe gout:
Pegloticase is a powerful IV drug that breaks down uric acid fast—like a cleanup crew for people with severe, stubborn gout that doesn't respond to pills.
It's usually for people with advanced gout, tophi, or joint damage who haven't improved with other meds. Think of it as the option when nothing else has worked.
It's given by infusion every two weeks in a clinic. This isn't a pill—you'll need to go in, sit down, and be monitored.
Fast. Most people see their levels drop within days. But it needs to be continued regularly to keep those levels down.
The big one is infusion reactions—sometimes serious. To reduce the risk, doctors often pair it with immune-suppressing drugs like methotrexate.
No—those meds can interfere with how pegloticase works. You'll likely need to stop them before starting treatment.
If your uric acid stays high or flares keep happening after a few infusions, your body might be making antibodies that block the drug.
It's expensive, requires infusions, and carries risks. But for people with uncontrolled gout, it can be life-changing.
Often yes—but prior authorization is almost always required. It's a specialty drug, so expect paperwork.
Not exactly. It can reverse damage and lower uric acid dramatically, but stopping the drug without a backup plan can lead to relapse.
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