Combination Therapy Advantageous for Patients with Gout

Gout occurs as the result of an accumulation of urate crystals in the joints, which cause pain and inflammation. In certain patients, big deposits of the crystals (tophi) form and can lead to further joint damage and inflammation, according to a study published by Arthritis & Rheumatology.

Current guidelines suggest that patients with tophaceous gout receive medication to reduce urate levels in the blood below 5-mg/dl to prevent adverse events.

The first-line therapy to lower urate levels is allopurinol or febuxostat. Both drugs are xanthine oxidase inhibitors that block the production of urate. However, despite the fact that these treatments are recommended, most patients are unable to achieve target blood levels of urate.

Included in a new phase 3 clinical trial were 324 patients with tophaceous gout who received treatment with monotherapy or a combination of gout drugs.

The authors discovered that significantly more patients receiving a combination of lesinuard plus an xanthine oxidase inhibitor achieved target levels of urate compared with patients in the febuxostat monotherapy cohort, according to the study.

Lesinurad works by inhibiting a uric acid transporter in the kidneys and increases excretion of uric acid in the urine, according to the study. A combination of lesinurad plus an xanthe oxidase inhibitor provides 2 ways to lower blood levels of urate.

The authors concluded that a combination of lesinurad and febuxostat may help patients achieve their target levels or urate in the blood.

"Combination treatment of lesinurad and febuxostat represents a new therapeutic option for patients with severe gout who cannot achieve the serum urate treatment target with xanthine oxidase inhibitor monotherapy," said lead author Nicola Dalbeth, MBChB, MD, FRACP.