Case Report: Pegloticase Treatment Beneficial for GFR Recovery

Known associations exist between gout and increased risk for cardiovascular disease, diabetes mellitus type 2, CKD, and death. Urate deposition in kidney tissue has been shown on kidney biopsy. In addition, there may be an association between decline in glomerular filtration rate (GFR) and the chronic inflammatory component of uncontrolled gout in patients with CKD. However, there is no established correlation between stabilization of chronic gout and renal protection outcomes. There remains a lack of effective therapies having a significant impact on urate tissue in chronic uncontrolled gout.

In conjunction with ASN Kidney Week 2024, Eddie M. Rodriguez, MD, of the Bayamon Medical Center, Puerto Rico, and colleagues published a case report of a patient with CKD stage 4 and uncontrolled gout. The report was titled GFR Recovery in a Patient With Stage 4 CKD and Chronic Uncontrolled Gout After Treatment With Intravenous (IV) Pegloticase.

The male patient was 59 years of age with a medical history of coronary artery disease, diabetes mellitus type 2, CKD stage 4, and uncontrolled gout with tophi and recurrent flares. Usual treatment for flares was prednisone and avoidance of colchicine and nonsteroidal anti-inflammatory drugs due to his CKD status. Following failure of those therapies to lower his urate acid level, the patient was initiated on pegloticase infusion IV every 2 weeks.

Following 6 months of treatment, the patient flares are controlled in addition to dissolution of tophi. He has also shown consistent improvement in eGFR. Prior to the initiation of treatment with pegloticase, his eGFR was 28 mL/min/1.73 m². At his 6-month visit, his eGFR was 70 mL/min/1.73 m², indicating “dramatic” improvement after stabilization of uncontrolled gout and removal of the urate burden from tissues.

At present, pegloticase is indicated for treatment of patients with uncontrolled gout regardless of GFR, with no required dose adjustments related to GFR. The data regarding benefits in terms of GFR recovery following treatment with pegloticase are only anecdotal to date.

“The findings of his case proposes that treatment with pegloticase IV could be beneficial for patients with uncontrolled gout in terms of eGFR recovery and also reduction in CKD progression by stabilizing chronic uncontrolled gout,” the researchers said. “Potentially this may lead to future controlled trials which may further evaluate pegloticase as a treatment for GFR recovery and GFR protection in patients with CKD and chronic gout.”

Source: Rodrigue EM, Calderon S, Quintero Alverez H. GFR recovery in a patient with stage 4 CKD and chronic uncontrolled gout after treatment with intravenous (IV) pegloticase. PUB575. Abstract of a poster published in conjunction with the American Society of Nephrology Kidney Week 2024; October 24-27, 2024; San Diego, California.