ISSUE 1508
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The FDA has approved lesinurad (Zurampic – Ironwood), a uric acid transporter 1 (URAT1) inhibitor, for adjunctive treatment of gout-associated hyperuricemia in patients whose serum uric acid levels fail to reach goal with xanthine oxidase inhibitor monotherapy.
STANDARD TREATMENT — Recent guidelines offer conflicting views on the benefits of monitoring serum uric acid levels and the appropriate use of urate-lowering therapy in patients with gout,1-3 but most expert clinicians still initially treat gout-associated hyperuricemia with a xanthine oxidase inhibitor such as allopurinol or febuxostat with the goal of reducing the serum uric acid level below 6.0 mg/dL (and preferably below 5.0 mg/dL). The uricosuric drug probenecid can be used for add-on therapy if target serum uric acid levels are not reached with a xanthine oxidase inhibitor alone or for initial therapy
... more- D Khanna et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64:1431.
- P Richette et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016 July 25 (epub).
- PG Shekelle et al. Management of gout: a systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med 2016 November 1 (epub).
- Drugs for gout. Med Lett Drugs Ther 2014; 56:22.
- JN Miner et al. Lesinurad, a novel, oral compound for gout, acts to decrease serum uric acid through inhibition of urate transporters in the kidney. Arthritis Res Ther 2016; 18:214.
- KG Saag et al. Lesinurad combined with allopurinol: randomized, double-blind, placebo-controlled study in gout subjects with inadequate response to standard of care allopurinol (a US-based study). Arthritis Rheumatol 2016 August 26 (epub).
- T Bardin et al. Lesinurad, a selective uric acid reabsorption inhibitor, in combination with allopurinol: results from a phase III study in gout patients having an inadequate response to standard of care (CLEAR 2). Ann Rheum Dis 2015; 74 (Suppl 2):545.
- N Dalbeth et al. Lesinurad, a novel selective uric acid reabsorption inhibitor, in combination with febuxostat, in patients with tophaceous gout: the CRYSTAL phase III clinical trial. Ann Rheum Dis 2015; 74 (Suppl 2):778.
- AK Tausche et al. Lesinurad monotherapy in gout patients intolerant to xanthine oxidase inhibitors (LIGHT): a randomized, double-blind, placebo-controlled, 6-month phase III clinical trial. Ann Rheum Dis 2015; 74 (Suppl 2):769.
- Inhibitors and inducers of CYP enzymes and P-glycoprotein. Med Lett Drugs Ther 2016 Aug 2 (epub). Available at: secure. medicalletter.org/downloads/CYP_PGP_Tables.pdf. Accessed November 10, 2016.

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