New therapeutic options for gout

Chronic hyperuricemia and acute arthritis in severe gouty patients can be difficult to manage, in particular in patients with renal failure or with history of cardio vascular conditions. Hopefully, new drugs hove been approved or will emerge, and will help to overcome these situations. Febuxostat has been recently approved in France for the treatment of chronic hyperuricemia in conditions where urate deposition has already occurred. Febuxostat is a novel non-purine, selective inhibitor of xanthine oxidase, metabolized and excreted by the liver, so no dose adjustment appears to be necessary in patients with mild-to-moderate renal impairment. Other novel hypouricemic drugs are the PEG-uricase (pegloticase), recently approved by the FDA, and a novel uricosuric drug (RDEA594), which is currently under development. The discovery that interleukin 1 beta (IL- beta) plays a key role in the pathogenesis of acute attacks of gout has prompted to assess the efficacy of IL-1 beta blockers in patients with acute gout. Biologic agents that inhibit IL-1 beta such as canakinumab, rilonacept and anakinra have shown promising results for the treatment of gouty arthritis.