Pegloticase (Krystexxa)

Pegloticase is a protein that is designed to treat severe chronic gout. The protein breaks down uric acid into a substance that the body can excrete. Pegloticase is indicated in patients in whom despite treatment with other medications (such as allopurinol, febuoxostat, probenecid, and other interventions) have failed to achieve the serum uric acid target, who continue to have frequent gout flares (≥2 flares/year) or who have non-resolving subcutaneous tophi.

How To Take It

Pegloticase is given through a needle inserted into a vein by a health care professional. The infusion lasts several hours and is given every two weeks. Treatment can result in gout flares, particularly upon initiation due to rapid lowering of urate concentrations. Using other medications for gout prophylaxis is recommended.

Your doctor will check your blood test for a condition known as G6PD deficiency because pegloticase is not safe if this is present.

Before every infusion, uric acid levels are checked. If the uric acid levels are measured above 6 mg/dL despite pegloticase infusions, it could indicate that antibodies have developed against the medication. This is an event that eventually occurs in nearly all patients receiving pegloticase but it is important to monitor as the development can result in loss of effectiveness and can predict the onset of a future infusion reaction.

Side Effects

The most common side effect is a gout attack. The most severe infusion reaction can be anaphylaxis, or a very severe allergic reaction. Tell your health care professional if you develop shortness of breath, wheezing, other unusual breathing sounds, lightheadedness, chest pain, or swelling inside the mouth.

Other side effects reported include nausea, itching, redness, bruising, constipation, and vomiting.

Tell Your Rheumatology Provider

Before taking pegloticase, tell your rheumatology provider if you plan to become pregnant. Studies of pegloticase in animals have shown some dangers in pregnancy, but it is unclear if it is dangerous in humans.

Tell your doctor if you have G6PD deficiency, or a family history of this. If G6PD deficiency is present, pegloticase is not safe.

Tell your doctor if there is any reason why you may not be able to receive the pegloticase at the recommended 2-week intervals for the foreseeable future. Since antibodies eventually form in nearly all patients receiving pegloticase, it is important to commit to every 2-week infusion so that the medicine can be most effective.

Updated February 2024 by Olga Petryna, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.