J Pharm Pract. 2017 Jan 01;897190017734427. doi: 10.1177/0897190017734427. Epub 2017 Jan 01.

Lesinurad, a Selective URAT-1 Inhibitor With a Novel Mechanism in Combination With a Xanthine Oxidase Inhibitor, for Hyperuricemia Associated With Gout.

Journal of pharmacy practice

Emily Huneycutt, Chase Board, Jennifer N Clements

PMID: 28980503 DOI: 10.1177/0897190017734427

Abstract

OBJECTIVE: To review the pharmacokinetics, clinical efficacy, safety, and role of lesinurad for the management of hyperuricemia associated with gout.

DATA SELECTION: A MEDLINE search (2000 to April 2017) was conducted using the terms hyperuricemia, gout, URAT-1, URAT-1 transporter, and lesinurad. Published articles and scientific posters relevant to the efficacy and safety of lesinurad were reviewed and summarized.

DATA SYNTHESIS: Lesinurad was evaluated in 3 randomized, phase 3 clinical trials (CRYSTAL, CLEAR 1 and 2). The primary endpoint for CRYSTAL trial was the percentage of patients achieving serum uric acid (SUA) concentration ≤ 5 mg/dL. The CLEAR 1 and 2 trials had a primary endpoint of percentage of patients achieving SUA concentration ≤ 6 mg/dL. Lesinurad at either 200 or 400 mg/d was superior to xanthine oxidase inhibitor (XOI) monotherapy in reducing the SUA concentration to 5 or 6 mg/dL, when added to either allopurinol or febuxostat.

CONCLUSION: Data from phase 3 clinical studies suggest the addition of lesinurad to allopurinol or febuxostat is superior to XOI monotherapy alone in reducing SUA concentrations while increasing the risk of renal-related adverse events. Lesinurad, 200 mg orally per day, would be a safe recommendation, in combination with an XOI, among patients with adequate renal function (i.e., above 45 mL/min) who need additional therapy for inadequately controlled hyperuricemia associated with gout.

Keywords: URAT-1 transporter; URAT-1 transporter inhibitor; gout; hyperuricemia; lesinurad; treatment

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• Journal Article