MCQ Blackboard Questions

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Question 1

What is the incidence of anti-drug antibody formation causing loss of treatment response with pegloticase use in the treatment of gout?
Question 1*
- A. Less than 5%
- B. 25%
- C. Anti-drug antibodies are rarely detected with pegloticase therapy
- D. 50%
Answer with a detailed explanation
B. 25%
Reference:
Lipsky PE, Calabrese LH, Kavanaugh A, Sundy JS, Wright D, Wolfson M, Becker MA. Pegloticase immunogenicity: the relationship between efficacy and antibody development in patients treated for refractory chronic gout. Arthritis research & therapy. 2014 Apr; 16:1-8.
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Question 2

When would you consider pegloticase in chronic tophaceous gout?
Question 2*
- A. A xanthine oxidase inhibitor is contraindicated
- B. Profound hyperuricaemic states e.g. bone marrow transplant
- C. Chronic refractory tophi over 3 years’ duration despite other forms of urate-lowering therapy
- D. All of the above
Answer with a detailed explanation
D. All of the above
Chronic tophaceous gout in the setting of any of the above conditions would reasonably warrant pegloticase use.
Pegloticase is a recombinant, pegylated mammalian uricase, different than other urate-lowering therapies in that it enzymatically degrades urate. Pegloticase also significantly decreases blood pressure in patients with chronic refractory gout which is a common co-morbidity and has been demonstrated to reduce the tophaceous burden by over 50% after 6 months of use.
Historically rasburicase is more often used in the bone marrow transplant cohort for hyperuricaemia due to its more rapid decline in serum uric acid, but the intensity of this treatment requires admission for IV hydration. Development of gout, particularly rapid escalation to tophaceous gout, is commonly reported in the years following bone marrow transplantation.
A consideration for the failure of response to pegloticase is the potential development of anti-drug antibodies.
References
Deliliers GL, Annaloro C. Hyperuricemia and bone marrow transplantation. Hyperuricemic Syndromes: Pathophysiology and Therapy. 2005; 147:105-14.
Schlesinger N, Lipsky PE. Pegloticase treatment of chronic refractory gout: Update on efficacy and safety. Seminars in Arthritis and Rheumatism 2020 Jun 1 (Vol. 50, No. 3, pp. S31-S38). WB Saunders.
Mandell BF, Yeo AE, Lipsky PE. Tophus resolution in patients with chronic refractory gout who have persistent urate-lowering responses to pegloticase. Arthritis Research & Therapy. 2018 Dec; 20:1-0.
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Question 1

What is the incidence of anti-drug antibody formation causing loss of treatment response with pegloticase use in the treatment of gout?

Answer with a detailed explanation

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Question 2

When would you consider pegloticase in chronic tophaceous gout?

Answer with a detailed explanation

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