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Table 1.  

Status of Agents Available or in Development for Urate Lowering in Gout


Update on Emerging Urate-Lowering Therapies

  • Authors: Saima Chohan, MD; Michael A. Becker, MD
  • CME Released: 8/7/2009
  • Valid for credit through: 8/7/2010
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Target Audience and Goal Statement

This activity is intended for primary care physicians, rheumatologists, and other physicians who care for patients with gout.

The goal of this activity is to review the current treatment of and 2 new medications for gout.

Upon completion of this activity, participants will be able to:

  • Describe patterns in the use of established treatments for gout and the efficacy of these medications
  • Identify the mechanism of action and efficacy of febuxostat
  • Specify adverse events more common with febuxostat compared with allopurinol
  • Describe outcomes of a phase 3 trial of pegloticase in the treatment of gout


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  • Saima Chohan, MD

    Rheumatology Section, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois


    Disclosure: Saima Chohan, MD, has disclosed no relevant financial relationships.

  • Michael A. Becker, MD

    Rheumatology Section, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois


    Disclosure: Michael A. Becker, MD, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P. Vega, MD, FAAFP

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine


    Disclosure: Charles P. Vega, MD, FAAFP, has disclosed no relevant financial relationships.


  • John Sundy, MD, PhD

    Section Editor, Current Opinion in Rheumatology


    Disclosure: John Sundy, MD, PhD, has disclosed that he has received grants for clinical research from and has served as an advisor or consultant to Savient Pharmaceuticals, Inc.; Arden Biosciences; and Regeneron Pharmaceuticals, Inc. Dr. Sundy has also disclosed that he has served as an advisor or consultant to Array BioPharma and Takeda Pharmaceuticals North America, Inc. and has received grants for clinical research from Genentech, Inc.

  • Mary Windle, PharmD, FACCP

    Site Editor, Medscape Rheumatology; Pharmacy Editor, eMedicine; Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Omaha, Nebraska


    Disclosure: Mary Windle, PharmD, FACCP, has disclosed that she owns stock with Pfizer Inc. and Avanir Pharmaceuticals.

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Update on Emerging Urate-Lowering Therapies

Authors: Saima Chohan, MD; Michael A. Becker, MDFaculty and Disclosures

CME Released: 8/7/2009

Valid for credit through: 8/7/2010


Abstract and Introduction


Purpose of Review: To discuss currently available urate-lowering therapeutic options for gout in the United States and newer therapeutic initiatives in development.
Recent Findings: Currently available urate-lowering drugs include allopurinol and probenecid. These drugs are effective but are often underdosed or underutilized, and caution must be taken in patients with multiple comorbidities. Newer therapeutic agents in development include febuxostat, a nonpurine analogue xanthine oxidase inhibitor, and pegloticase, a pegylated recombinant uricase.
Summary: There have been no new US Food and Drug Administration-approved urate-lowering drugs for gout in the past 40 years. Recent advances in therapeutics promise to provide the opportunity for much needed improvement in patient outcomes in this disorder.


Gout is the most common form of inflammatory arthritis in men, affecting 1-2% of adult men in Western countries[1] and an increasing number of postmenopausal women.[2] Several recent reports document increases in the incidence[3-5] and prevalence[2,4-6] of gout in the last few decades. There is consensus and evidence for the view that achievement and maintenance of serum urate levels (sUAs) below the limit of urate solubility in extracellular fluids (6.8 mg/dl) are necessary for long-term success in treatment of patients with persistent or progressive gouty symptoms. In accord with these aims, goal ranges adopted for sUA maintenance in clinical studies and evidence-based guidelines have included less than 6.0 mg/dl[7-10,11•] and the more stringent less than 5.0 mg/dl levels.[12•,13•,14••]

Potent urate-lowering agents, effective in many gout patients, have been available for many years, but recent reports of suboptimal clinical outcomes in many current gout patients suggest that contemporary use of urate-lowering therapeutic options has not kept pace.[15-17] In response to this medical need, multiple urate-lowering initiatives have been launched with the aim of reducing clinical expression and progression of the disease. Here, we review the limitations of current urate-lowering treatment options and two promising new therapeutic agents.