Lesinurad

Lesinurad Brand Name– ZURAMPIC

What is Lesinurad

Lesinurad is a uricosuric agent that is a urate transporter (URAT1) inhibitor. It is used for the adjunct treatment of hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone.

Lesinurad product labeling carries a boxed warning regarding the risk of acute renal failure, which is more common when lesinurad was administered as monotherapy and with higher than FDA-approved doses during clinical studies.

Therefore, lesinurad should always be used in combination with a xanthine oxidase inhibitor (XOI) such as allopurinol or febuxostat. Lesinurad should not be used if a patient has persistent renal impairment, as defined by a creatinine clearance of less than 45 mL/minute.

For chronic gout management, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) guidelines recommend urate lowering therapy (ULt) to achieve a target serum uric acid (sUA) level of less than 6 mg/dL to prevent the formation of crystals and to eliminate crystal deposition, thereby dissolving tophi.

A lower target (less than 5 mg/dL) is recommended for patients with severe disease. Allopurinol and febuxostat appear relatively similar as monotherapy in lowering serum urate concentrations and reducing gout flares with long-term (more than 1 year) of use and are generally first-line options.

Treatment guidelines recommend combination therapy (e.g., an XOI plus lesinurad) when treatment goals are not met with initial monotherapy; the use of pegloticase is usually reserved for severe, refractory chronic gout.

Indications

  • gout
  • gouty arthritis
  • hyperuricemia

For the adjunct treatment of hyperuricemia due to gout (gouty arthritis) in patients not achieving target serum uric acid levels with a xanthine oxidase inhibitor alone

Side Effects

  1. gastroesophageal reflux
  2. headache
  3. influenza
  4. myocardial infarction
  5. nephrolithiasis
  6. renal failure (unspecified)
  7. stroke

Monitoring Parameters

  • serum creatinine
  • serum uric acid

Contraindications

  • breast-feeding
  • dialysis
  • hepatic disease
  • kidney transplant
  • Lesch-Nyhan syndrome
  • organ transplant
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • secondary hyperuricemia
  • tumor lysis syndrome (TLS)

Interactions

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