Gout therapy with pegloticase, methotrexate maintained eGFR vs. placebo
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Key takeaways:
- Twelve-month data from the MIRROR trial showed combined use of pegloticase and methotrexate reduced symptoms of gout and stabilized eGFR.
- Patients did not experience any toxicity from use of methotrexate.
AUSTIN, Texas — Results from a poster presentation here showed that patients with uncontrolled gout treated with the combined therapy of pegloticase and methotrexate saw a reduction in gout symptoms as well as a stable eGFR.
Twelve-month data from the MIRROR trial showed a higher response rate among patients with chronic kidney disease when pegloticase (Krystexxa, Horizon Pharmaceuticals) was combined with methotrexate (MTX) vs. pegloticase and placebo.
Patients using the combined therapy did not see a change in eGFR, data showed.
“Gout is common in advanced CKD [patients] and associated with CKD progression,” Abdul Abdellatif, MD, of Baylor College of Medicine, and colleagues wrote in the poster presented at the National Kidney Foundation Spring Clinical Meetings. “Pegloticase lowers serum urate (SU) in CKD [patients] with uncontrolled gout,” they wrote.
“[The] MIRROR [randomized controlled trial] showed higher response rate with methotrexate (MTX) vs. placebo (PBO) co-therapy (71.0% vs. 38.5%), but MTX use has been limited by potential risk for adversely impacting eGFR in CKD [patients].”
In the MIRROR trial, baseline characteristics of the MTX group (n = 100) included 91% men with an eGFR of about 68.9 mL/min/1.73 m2 and a placebo group of 85% men (n = 52) with a baseline eGFR of about 71.1 mL/min/1.73 m2.
In an interview with Healio Nephrology, Brad Marder, MD, one of the authors of the poster, said all patients in the trial were exposed to the same dose of MTX – 15 mg once a week – and the same dose of pegloticase – 8 mg intravenously every 2 weeks.
“What was interesting in this study is that we were trying to show the safety of [MTX] with this patient group at that dose despite the fact that many of them had underlying stage 3 [CKD],” Marder said. “The take-home message is that when you look at patients who were exposed to [MTX], everything is completely stable,” Marder said. “When you look at CKD changes after pegloticase was started, both the placebo group and the [MTX] group continued to have stable GFRs throughout the pegloticase part of the trial.”
The authors said further study is needed “to better understand the long-term effects of sustained urate-lowering on eGFR, particularly in patients with and without gout and advanced CKD.
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Abdellatif A, et al. #232. Presented at: National Kidney Foundation Spring Clinical Meetings; April 11-15, 2023; Austin, Texas.
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