Lesinurad (Zurampic): A New Option for Gout Treatment
Gout is a type of inflammatory arthritis that occurs when uric acid crystals build up in the joints, causing pain, swelling, and stiffness. Uric acid is a waste product that is normally excreted by the kidneys. However, some people have high levels of uric acid in their blood (hyperuricemia) due to either overproduction or underexcretion of uric acid, or both.
One of the main goals of gout treatment is to lower the uric acid levels in the blood to prevent the formation of new crystals and dissolve the existing ones. This can reduce the frequency and severity of gout attacks and prevent joint damage and complications. The standard treatment for lowering uric acid levels is a class of drugs called xanthine oxidase inhibitors, such as allopurinol or febuxostat. These drugs work by blocking an enzyme that is involved in the production of uric acid.
However, some people may not achieve their target uric acid levels with xanthine oxidase inhibitors alone, either because they cannot tolerate the optimal dose or because they have a high rate of uric acid excretion. For these people, a new drug called lesinurad (Zurampic) may offer an additional benefit. Lesinurad is a urate transporter inhibitor that works by increasing the amount of uric acid that is removed by the kidneys. It is approved by the FDA and the EMA for use in combination with a xanthine oxidase inhibitor in patients with gout who have not reached their target uric acid levels with a xanthine oxidase inhibitor alone.
How to use lesinurad
- Lesinurad is available as a tablet that is taken once daily in the morning with food and water.
- The recommended dose is 200 mg per day.
- Lesinurad should always be taken together with a xanthine oxidase inhibitor, such as allopurinol or febuxostat.
- Lesinurad should not be used by itself, as this may increase the risk of kidney failure.
- Lesinurad should not be used in patients with severe kidney impairment, kidney transplant, hemodialysis, tumor lysis syndrome, or Lesch-Nyhan syndrome.
- Lesinurad should be used with caution in patients with liver problems, heart disease, stroke, pregnancy, or breastfeeding.
- Patients taking lesinurad should drink at least 2 liters of fluid per day to prevent dehydration and kidney stones.
- Patients taking lesinurad should have regular blood tests to monitor their kidney function and uric acid levels.
What are the benefits of lesinurad?
Clinical trials have shown that lesinurad, when added to a xanthine oxidase inhibitor, can significantly lower the uric acid levels in patients with gout who have not achieved their target levels with a xanthine oxidase inhibitor alone. This can reduce the risk of gout flares and improve the quality of life for patients with gout.
What are the side effects of lesinurad?
The most common side effects of lesinurad are headache, flu, increased blood creatinine (a marker of kidney function), and heartburn. These side effects are usually mild and transient.
The most serious side effect of lesinurad is acute renal failure (kidney failure), which can occur if lesinurad is taken without a xanthine oxidase inhibitor or if the patient becomes dehydrated or has other risk factors for kidney problems. Therefore, it is important to follow the dosing instructions carefully and to drink enough fluids while taking lesinurad.
Other rare but serious side effects of lesinurad include hypersensitivity reactions (such as rash, itching, swelling, or difficulty breathing), liver injury, and cardiovascular events (such as heart attack or stroke).
How does lesinurad compare to other drugs for gout?
Lesinurad is not a substitute for xanthine oxidase inhibitors, but rather an add-on therapy for patients who need additional uric acid lowering. It has a different mechanism of action than xanthine oxidase inhibitors, as it works by enhancing the renal excretion of uric acid rather than inhibiting its production.
There are other drugs that can also increase the renal excretion of uric acid, such as probenecid and benzbromarone. However, these drugs are not widely available or approved in some countries, and they may have more interactions and contraindications than lesinurad. Lesinurad has been shown to be more effective and better tolerated than probenecid in clinical trials.
Another option for patients who do not respond to xanthine oxidase inhibitors is pegloticase, a biologic drug that converts uric acid into a harmless substance. However, pegloticase is very expensive, requires intravenous infusion every two weeks, and can cause severe allergic reactions and anemia in some patients.
Conclusion
Lesinurad (Zurampic) is a new drug for the treatment of hyperuricemia associated with gout. It is used in combination with a xanthine oxidase inhibitor in patients who have not reached their target uric acid levels with a xanthine oxidase inhibitor alone. Lesinurad can lower the uric acid levels by increasing the renal excretion of uric acid. Lesinurad can reduce the risk of gout flares and improve the quality of life for patients with gout. Lesinurad should not be used by itself, as this may cause kidney failure. Lesinurad should be taken with food and water, and patients should drink at least 2 liters of fluid per day while taking lesinurad. Lesinurad may cause some side effects, such as headache, flu, increased blood creatinine, and heartburn. Rare but serious side effects include acute renal failure, hypersensitivity reactions, liver injury, and cardiovascular events.