Pegloticase (Krystexxa)

medicine injections

Pegloticase is a protein that is designed to treat severe chronic gout when other more common treatments have failed or are not tolerated.  More specifically, 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 nonresolving subcutaneous tophi.

How to Take It

Pegloticase is given as an infusion, through a needle inserted into one of the veins by a health care professional. The infusion lasts at least two hours and is given every two weeks. Treatment with pegloticase can result in gout flares, particularly upon initiation due to rapid lowering of urate concentrations. Using other medications for gout prophylaxsis is recommended beginning ≥1 week before initiation of pegloticase and continuing for at least 6 months to prevent flares.

Prior to receiving the first infusion, your doctor should check for a condition known as G6PD deficiency because pegloticase is not safe if this is present as it can result in a dangerous problem with the blood.

Prior to receiving each infusion, it is important to check uric acid levels. 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 of pegloticase and can predict the onset of a future infusion reaction.

Side Effects

The most common side effect is a gout attack, which is why a medication to prevent a gout attack should always be given while receiving pegloticase.

The most severe infusion reaction can be anaphylaxis, or a very severe allergic reaction, that could result in serious harm or death if not identified and treated quickly. Immediately 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 on pregnancy in animals have shown some dangers in pregnancy, but it is unclear if it is dangerous in humans.

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

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

During infusions, immediately tell your health care professional if you develop shortness of breath, wheezing, other unusual breathing sounds, lightheadedness, chest pain, or swelling inside the mouth. This could indicate anaphylaxis, a potentially dangerous or deadly reaction to pegloticase.

Updated February 2022 by Kanika Monga, 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.

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