New and emerging therapies for gout

Author(s): Daria B Crittenden, Han Na Kim, Mark C Fisher, David S Goldfarb, Michael H Pillinger

After nearly 50 years, new drugs are now available or in development for gout. Febuxostat (approved 2009) selectively inhibits xanthine oxidase, preventing uric acid formation and lowering serum urate. Pegloticase (approved 2010) is a recombinant chimeric mammalian uricase that corrects the intrinsic human uricase deficiency. Pegloticase reduces serum urate, and may have particular efficacy against tophi. IL-1b is now understood to be a central actor in acute gouty inflammation. Three IL-1b antagonists – anakinra, rilonacept and canakinumab (all US FDA approved for other uses) – are being evaluated for gout treatment and/or prophylaxis. The renal urate resorbing transporters URAT1 and GLUT9 have been recently characterized as targets of uricosuric drugs; two pipeline drugs, RDEA594 and tranilast, inhibit these transporters and are promising urate-lowering therapies.