Rasburicase and Gout
Posted by GoutPal in Gout, Gout Cures, tags: rasburicase, rasburicase and gout, _allopurinol, _puricase, _reducing uric acid research, _uric acidRasburicase is a genetically engineered enzyme. It causes uric acid to break down to allantoin which is more soluble, and easily excreted by the kidneys.
Though rasburicase is very effective at reducing uric acid levels, it is not approved for long term use. FDA approval is limited to counteracting the effects of chemotherapy in children over a maximum of 5 days.
There have been a small number of European studies of rasburicase and gout, but I am not aware of any proper clinical trials.
Tausche and Schroder comment in Annals of the Rheumatic Diseases that the main dilemma…
… is not the high cost but the missing approval by the FDA in severe tophaceous gout.
Of course, mass production might bring the cost down, but rasburicase has another drawback. It is administered intravenously, over a 30 minute period.
A similar drug, Puricase, is currently undergoing trials. FDA submission is expected late this year, or early next year.
The intention for both these drugs is that they will only be considered when other treatments, usually allopurinol, have failed or are inappropriate.
What are your views on rasburicase and gout?
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I’ve just been reminded about a study called Safety and Efficacy Of Rasburicase in Patients with Tophaceous Gout and Intolerant or Unresponsive to Allopurinol, presented at the ACR conference last year. I didn’t include it in my review in my December 2006 Newsletter, as I didn’t feel that rasburicase would become a mainstream gout treatment.
The study covered 10 patients who could not tolerate allopurinol, or found it ineffective. It concluded that rasburicase was generally safe and well tolerated and uric acid levels were substantially reduced after 6 months.
My reminder about this study came in the form of Terkeltaub’s review of American College of Rheumatology’ 70th Annual Meeting. In his Update on Crystal-Induced Arthritis he notes
I think this means that Puricase is better because your immune system can attack rasburicase, possibly leading to an extreme allergic reaction, which might stop it working.
As of October 16th this year, rasburicase approval is extended in the US to include adult chemotherapy patients. It remains as a daily intravenous infusion limited to a five day course.
The brand name is Elitek, manufactured by Sanofi Synthelabo.
I am preparing a reference page on GoutPal.com, which should appear soon.