Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment. Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (− 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL. Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation. Information about gout treatment following pegloticase discontinuation is limited. We found that after discontinuing pegloticase, patients frequently used oral ULTs (86% of those discontinuing pegloticase). Approximately 77% started ULTs or restarted pegloticase within 6 months of pegloticase discontinuation. This gap in switching to another ULT suggests greater need for more optimal management of gout patients who discontinue pegloticase or have meaningful gaps in treatment. Approximately 58% of patients who restarted pegloticase had a SU < 6 mg/dL as measured at a median (IQR) interval of 45.5 (39.8, 53.0) days. The context for pegloticase interruptions needs to be further explored.

中文翻译：

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聚乙二醇化酶停药后痛风患者的降尿酸治疗、血清尿酸、炎症生物标志物和肾功能

关于聚乙二醇停药后的长期临床结果或降尿酸 (ULT) 治疗的使用知之甚少。我们检查了 ULT 使用、血清尿酸 (SU)、炎症生物标志物以及聚乙二醇酶停药后的肾功能。我们使用风湿病信息学有效性系统 (RISE) 注册中心对 2016 年 1 月 1 日至 2022 年 6 月期间停用聚乙二醇化酶的痛风患者进行了回顾性分析。我们将停药定义为距离上次输注≥12周。我们在最后一次给药后两周开始检查结果，并确定了聚乙二醇停药后的 ULT 治疗。我们评估了实验室值（SU、eGFR、CRP 和 ESR）的变化，比较治疗中（第二次聚乙二醇化酶剂量≤ 15 天）与治疗后。在 375 名停用聚乙二醇化酶的痛风患者中，停用后中位 (IQR) 实验室变化为： SU：+2.4 mg/dL (0.0,6.3)； eGFR：-1.9 mL/min (− 8.7,3.7)； CRP：-0.8毫克/升（-12.8，0.0）； ESR：-4.0 毫米/小时 (-13.0,0.0)。停药后的治疗包括口服 ULT（86.0%）、重新开始聚乙二醇化酶（4.5%）和无 ULT 记录（9.5%），不包括当天服用多种处方的患者 (n = 17)。聚乙二醇酶后口服 ULT 为：62.7% 别嘌呤醇，34.1% 非布索坦。开始/重新开始 ULT 的中位时间 (IQR) 为 92.0 天 (55.0,173.0)。 ULT 处方后（≥ 30 天），只有 51.0% 的患者 SU < 6 mg/dL。重新开始聚乙二醇化酶的患者的中位 SU 为 0.9 mg/dL (IQR:0.2,9.7)，58.3% 的 SU < 6 mg/dL。 Peloticase 可治疗对黄嘌呤氧化酶抑制剂反应失败的患者不受控制的痛风，但对于停药的患者，最佳治疗方案尚不清楚。根据此分析，开始另一次 ULT 的人中只有一半实现了 SU 目标。需要密切随访以优化聚乙二醇停药后的结果。有关聚乙二醇停药后痛风治疗的信息有限。我们发现，停用聚乙二醇化酶后，患者经常使用口服 ULT（其中 86% 的患者停用聚乙二醇化酶）。大约 77% 的患者在聚乙二醇停药后 6 个月内开始 ULT 或重新开始聚乙二醇治疗。切换到另一种 ULT 的这种差距表明，对于停止聚乙二醇化酶或在治疗中有有意义的差距的痛风患者，更需要更优化的管理。大约 58% 重新开始聚乙二醇化酶的患者的 SU < 6 mg/dL，中位 (IQR) 间隔为 45.5 (39.8, 53.0) 天。需要进一步探讨聚乙二醇酶中断的背景。