Recombinant uricase for refractory gout
Pegloticase
A specialist drip used to lower uric acid in severe chronic gout that other treatments have not been able to control.
What is Pegloticase?
Pegloticase is a specialist medicine used to treat severe, long-standing gout in people whose uric acid levels cannot be controlled by the usual tablets. It works as a man-made version of an enzyme that breaks down uric acid, turning it into a substance the body can easily get rid of, so the crystals that cause gout can dissolve. It is given as a drip into a vein at a hospital or clinic, where staff can watch for reactions. It is used only when other treatments have not worked, and it needs careful monitoring because allergic-type reactions to the drip can happen.
Education and reference only. This is a plain-language guide to Pegloticase — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Pegloticase is a specialist medicine for severe, chronic gout that has not responded to the usual urate-lowering tablets such as allopurinol or febuxostat. Gout is caused by high levels of uric acid in the blood, which form sharp crystals in the joints and tissues, leading to painful attacks and lumps known as tophi. Pegloticase is a laboratory-made form of an enzyme called uricase, which humans do not naturally have in an active form. It is given as a drip into a vein under hospital or clinic supervision, and it is reserved for people who have run out of other options.
How it works
Pegloticase acts as an enzyme that breaks uric acid down into a more soluble substance called allantoin, which the body can pass out in the urine far more easily than uric acid itself. By rapidly lowering uric acid levels, it allows the crystals that have built up in joints and tissues over years to dissolve, which can shrink tophi and reduce attacks over time. Because it lowers uric acid quickly and powerfully, gout flares can actually become more common in the first months as old crystals break up, which is why other anti-inflammatory cover is usually given alongside it at the start.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist medicine used in the UK to treat severe, long-standing gout that has not been controlled by other treatments, given as a drip into a vein.
What it treats
Conditions Pegloticase is used for
Practical use
How to take Pegloticase
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as a slow drip into a vein at a hospital or clinic, on a regular schedule arranged by your specialist team.
- Plan to stay for a period of observation afterwards, so staff can watch for any reaction to the drip.
- Expect to be given other medicines beforehand to lower the chance of an allergic-type reaction.
- Keep taking any anti-inflammatory cover you are prescribed, as gout flares can get worse when treatment first starts.
- Attend the blood tests before each drip, as a rising uric acid level helps the team decide whether to continue.
Weighing it up
Advantages & disadvantages of Pegloticase
Advantages
- Can powerfully lower uric acid and dissolve crystals in severe gout that other treatments have not controlled.
- Can shrink tophi and reduce attacks over time in people who have run out of other options.
- Offers a treatment route for disabling chronic gout where tablets have failed.
Disadvantages
- Must be given as a drip into a vein at a hospital or clinic rather than taken at home.
- Allergic-type reactions to the infusion can happen, sometimes serious, so close monitoring is needed.
- Gout flares often get worse in the first months of treatment as old crystals dissolve.
Practical use
Good to know
The most important thing to understand about pegloticase is that it is a last-resort treatment, used only when the standard tablets have failed or cannot be taken, and that it is given as a drip rather than a tablet. A key safety point is that allergic-type reactions to the infusion can happen, sometimes serious ones, so it is given where staff can watch you closely and treat any reaction, and you are usually given other medicines beforehand to reduce the risk. Your uric acid level is checked before each drip, because if it starts to climb again it can be a warning sign that the medicine is no longer working and that the risk of a reaction is higher. Gout flares often get worse for a while when treatment first begins, as long-standing crystals dissolve, so anti-inflammatory cover is usually given to manage this. It is not suitable for people with the inherited condition G6PD deficiency, which is checked before treatment.
Who should not take it / use with caution
- People who have had a serious allergic reaction to pegloticase should not have it.
- People with the inherited condition G6PD deficiency must not have it, because of the risk of red-blood-cell breakdown, so this is checked first.
- It is used with care in people with heart failure, and only under specialist supervision with monitoring.
Monitoring
- A blood test for G6PD deficiency before treatment starts, as it cannot be used if this is present.
- Checking the uric acid level before each drip, as a rising level can signal the medicine is no longer working.
- Watching closely during and after each infusion for allergic-type reactions.
Side effects
- Gout flares, which often get worse in the first months as long-standing crystals dissolve.
- Allergic-type or infusion reactions during or after the drip, which staff watch for closely.
- Nausea, bruising at the drip site, or a sore throat in some people.
Key interactions
- It is not used together with the usual urate-lowering tablets, which can mask a warning sign that it has stopped working.
- Other medicines that affect the immune system or cause reactions should be discussed with your specialist team.
- Tell your team about all your medicines, as a full list helps keep treatment safe.
Available as: A solution given as a drip into a vein.
Answers
Pegloticase: frequently asked questions
What is pegloticase used for?
It is used to treat severe, long-standing gout in people whose uric acid cannot be controlled by the usual tablets, by breaking uric acid down so crystals can dissolve.
Why is it given as a drip?
It is a man-made enzyme that has to be given into a vein, and being given in a clinic also means staff can watch for and treat any reaction.
Why might my gout get worse at first?
As the medicine quickly dissolves crystals that have built up over years, flares can become more common for a while, so anti-inflammatory cover is usually given at the start.
Why do I need blood tests before each drip?
Your uric acid level is checked because if it starts rising again it can warn the team that the medicine is no longer working and that the risk of a reaction is higher.
Is it a first treatment for gout?
No. It is reserved for severe gout that has not responded to the usual tablets, and it is given under specialist supervision because of the risk of reactions.
Authoritative sources
- BNF
- NICE CKS
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