Brian LaMoreaux, MD: Defining and Achieving Remission in Gout with Pegloticase

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A post hoc analysis of the MIRROR trial suggests comprehensive gout management should aim for remission, incorporating both uric acid lowering and broader symptom improvements.

The MIROR program was originally developed to test the idea that concomitant methotrexate and pegloticase therapy could prevent the development of anti-drug antibodies, which often limit the treatment's effectiveness. The results were very successful. Patients with gout receiving methotrexate had a 71% response rate at 6 months, compared with 39% for those receiving a placebo. These results were also sustainable, with response rates at 12 months of approximately 60% for the methotrexate group and 30% for the placebo group.

In an interview with HCPLive, Brian LaMoreaux, MD, executive medical director at Amgen, discussed a post hoc analysis of the trial which focused on gout remission among these patients. Data were presented at the 2024 European Congress of Rheumatology (EULAR).

Remission in gout has not been as clearly defined as in other diseases like rheumatoid arthritis. Traditional oral therapies modestly lower uric acid, which may not be enough to see significant benefits within 6 to 12 months.

Therefore, the team developed remission criteria including low uric acid levels, tophi improvement, reduction in gout flares, and patient-reported outcomes. At the 12-month mark, 47% of patients met these strict criteria, signifying that within 6 to 12 months of therapy, patients can achieve not just lower uric acid but also broader benefits.

LaMoreaux and his team also plan to explore and potentially simplify the remission criteria to ensure they are easily adoptable.

When discussing treatment with patients, he explained it is important to highlight that while uric acid lowering is a primary goal, it also leads to reduced pain, fewer flares, and improved joint function. This conversation helps patients understand the full benefits of their treatment.

For a treatment like pegloticase, logistical improvements, such as more convenient infusion schedules, could further enhance patient care. LaMoreaux believes these findings contribute significantly to the discussion on gout remission, emphasizing the need to define clear treatment goals.

“Gout continues to be mislabeled as a lifestyle disease,” he concluded. “It's a genetic and renal disease with lifestyle components, but lifestyle is never going to be the answer to treat gout, even though it might contribute to some people getting gout. Recognizing this as an inflammatory disease that warrants aggressive therapy will improve patient lives.”

Disclosures: LaMoreaux is an employee of Amgen and has stock options.