Trends in Immunomodulation Co-Therapy with Pegloticase for Uncontrolled Gout Interview with:

Brian LaMoreaux, M.D., M.S. Medical Director, Medical Affairs Horizon Therapeutics

Dr. LaMoreaux

Brian LaMoreaux, M.D., M.S.
Medical Director, Medical Affairs
Horizon Therapeutics What is the background for this study?

Response: Pegloticase is a PEGylated biologic therapy for patients with uncontrolled gout who have not improved on or could not tolerate conventional urate-lowering therapies. All biologics have the ability to engender anti-drug antibodies (ADAs) and it is known that some patients given pegloticase develop ADAs that cause them to stop treatment prior to receiving a complete course of therapy.

In other rheumatic autoimmune diseases, DMARDs such as methotrexate or azathioprine are used as standard of care to prevent the development of ADAs to biologics. These DMARDs often allow patients to remain on biologic therapies longer and receive the full therapeutic benefits while minimizing adverse events. While pegloticase has been used traditionally as monotherapy, recent case series have demonstrated the therapeutic benefit of immunomodulator co-administration, allowing more patients to receive a full course of pegloticase therapy. Little has been published on how widespread this practice is and whether it has changed over time. What are the main findings? 

Response: This analysis examined records from an IQVIA medical claims database from 2014 – 2019 of patients diagnosed with gout or chronic kidney disease (CKD) to identify patients who had received pegloticase. Patients who had received pegloticase were classified as having been on an immunomodulating co-therapy if they were prescribed methotrexate or azathioprine within 60 days before or after initiation of their first pegloticase infusion. The analysis found relatively steady, low rates of immunomodulation (1-4%) between 2014-2018. In 2019, there was an increase in initiation of immunomodulation therapy with pegloticase (15%) beginning soon after November 2018, which indicates that clinicians began to more frequently employ a strategy of DMARD co-treatment with pegloticase in 2019 to improve response rates. What should readers take away from your report?

Response: While pegloticase has been traditionally used as a biologic monotherapy, this analysis adds to the growing body of research showing that practicing clinicians are aware of and adopting immunomodulation co-therapy with pegloticase to improve outcomes for patients with uncontrolled gout. What recommendations do you have for future research as a result of this work?

Response: Again, I would encourage investigators to continue to explore outcomes for patients with uncontrolled gout co-treated with pegloticase and an immunomodulator. Publications on this topic have repeatedly shown that this approach to pegloticase can increase treatment efficacy without sacrificing safety. Is there anything else you would like to add? Any disclosures?

Response: Uncontrolled gout is a serious condition. It’s critical for people to realize that gout is a chronic condition linked to other conditions like cardiovascular disease and kidney disease – and that proper treatment is important to avoid lasting damage to the body.

Disclosures: I am a medical director at Horizon and a volunteer clinical rheumatologist with CommunityHealth 

Citation: EULAR 2020 Abstract


  1. Lamoreaux1, M. Francis-Sedlak1, K. Svensson1, R. Holt1

1Horizon Therapeutics, Lake Forest, United States of America



Last Modified: Jun 15, 2020 @ 12:07 am

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