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Rasburicase for Tophaceous Gout Not Treatable with Allopurinol: An Exploratory Study PASCAL RICHETTE, CLAIRE BRIÈRE, VIRGINIE HOENEN-CLAVERT, DAMIEN LOEUILLE, and THOMAS BARDIN
ABSTRACT. Methods. Five patients received 6 monthly infusions of rasburicase (Group 1) and 5 received 5 daily infusions (Group 2). Results. In Group 1, serum uric acid (SUA) level decreased significantly, from 612.6 ± 162.4 µmol/l at baseline to 341.2 ± 91.8 µmol/l after 6 infusions (p = 0.001). Changes in tophus area were observed in 2 patients. In Group 2, daily infusions produced a rapid, marked decrease in SUA level during treatment. Yet SUA levels measured at 1 month (511.5 ± 128.4 µmol/l) and 2 months (572 ± 96.2 µmol/l) after treatment were not significantly lower than at baseline (573.6 ± 48.2 µmol/l). No patient from Group 2 showed reduced tophus size. Eight of 10 patients experienced an adverse event, the most common being gout flare despite prophylactic treatment with colchicine. Conclusion. Monthly infusions of rasburicase appear to be a possible therapy for severe gout not treatable by other means. Tolerance of rasburicase in gout appears to be diminished by frequent triggering of gout attacks, and hypersensitivity reactions might be an important limitation to longterm therapy. (First Release Sept 15 2007; J Rheumatol 2007;34:2093-8) Key Indexing Terms:
GOUT From the Université Paris 7, UFR Médicale, Assistance Publique-Hôpitaux de Paris, Fédération de Rhumatologie, Hôpital Lariboisière, Paris; and Hôpitaux de Brabois, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-les-Nancy, France. P. Richette, MD, PhD; C. Brière, MD; T. Bardin, MD, Hôpital Lariboisière; V. Hoenen-Clavert, MD; D. Loeuille, MD, PhD, Hôpitaux de Brabois. Address reprint requests to Prof. T. Bardin, Fédération de Rhumatologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75475 Paris cedex 10, France. E-mail: thomas.bardin@lrb.aphp.fr Accepted for publication June 8, 2007. |
