Patients with gout treated with pegloticase, methotrexate have lower blood pressure
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PHILADELPHIA — Pegloticase and methotrexate can be used to reduce blood pressure in patients with gout, hinting at a link between serum uric acid level and hypertension, according to data presented at the ASN Kidney Week conference.
In the MIRROR randomized controlled trial, lower blood pressure was noted in patients both with and without chronic kidney disease, although the differences were more pronounced in patients without chronic kidney disease.
“When you profoundly lower these patients’ serum uric acid with pegloticase. you are getting a very clear blood pressure response of both systolic blood pressure and diastolic blood pressure,” said Brad Allan Marder, MD, medical director of nephrology at Horizon Therapeutics.
“That reinforces our idea that high serum uric acid levels may be contributing to hypertension in these patients that have a high risk for hypertension and heart and kidney disease along with their gout. It also even more powerfully shows that by lowering the serum uric acid, you actually do get a nice reduction in blood pressure.”
The blood pressure data was a secondary endpoint from a trial that examined the efficacy of pegloticase combined with methotrexate in patients with uncontrolled gout. The common presence of hypertension in patients with gout led Marder and his team to further examine the effects of the treatment on blood pressure.
“One of the big comorbidities that exists with gout is a high prevalence of hypertension, and what we found in our baseline look at these patients was about 62% to 65% of patients with uncontrolled gout in the study actually had a diagnosis of hypertension,” Marder said. “This is particularly impactful, because not only is the comorbidity of hypertension high in these patients, but also these patients have a high risk for chronic or acute kidney disease and heart disease, and we know that both of those end-organ diseases are influenced tremendously by blood pressure, and particularly by uncontrolled blood pressure.”
The study examined a sample of 152 patients, 89% of whom were men, and 100 of whom received methotrexate along with pegloticase. The MIRROR trial found higher overall response rates in patients receiving that treatment, but also found sustained lower blood pressure rates among both populations.
Marder said these results could have further implications for the use of methotrexate to lower blood pressure for patients with other medical conditions.
“There have been trials looking at the use of methotrexate for other diseases like rheumatoid arthritis that have also shown that methotrexate does have some blood pressure lowering effect compared with placebo,” Marder said. “So that was a very interesting finding, and it was particularly important to show, because the use of methotrexate —particularly in patients with chronic kidney disease, and many of these patients in the trial also had chronic kidney disease — that it’s something that many health care providers would look at using.”
Reference:
- Marder B, et al. Blood pressure changes with intensive urate lowering in uncontrolled gout patients with and without CKD. Presented at: ASN Kidney Week; November 2-5, 2023; Philadelphia.
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