I’ve followed Krystexxa from its early development as PEG-uricase. Medically, it’s now called pegloticase, and Krystexxa is a brand name for it. You can search for Krystexxa, pegloticase, or PEG-uricase in the search box at the top of every GoutPal page. There’s some fascinating information including a picture showing how pegloticase clears gouty tophi in weeks. Krystexxa has been extensively trialed. So, it’s better to call it “cutting edge” rather than experimental.
I’ve merged this topic with the Krystexxa discussion that Patrick refers.
Most animals don’t have uric acid in their blood. Because, they produce an enzyme, called uricase, that breaks down uric acid soon after it is produced. Early attempts to treat gout patients with uricase failed, as our bodies rejected the foreign enzyme. Scientists took uricase from pigs, and genetically engineered it to try and avoid the human rejection problem. They now grow the culture as a fungus, to provide pegloticase. Rejection problems have not yet been totally overcome. So, some patients cannot tolerate the treatment. And, for all patients, it’s a one-off treatment. That’s because our immune system produces antibodies during the course of treatment. Eventually, these antibodies make the treatment ineffective. But, once all your uric acid burden has been dissolved, it will be several years before crystals grow again. Often, this can be controlled with tolerable doses of other uric acid lowering drugs.
Krystexxa is a lifesaver for patients who cannot tolerate other forms of uric acid lowering treatment. But, it’s usually a last resort, where allopurinol or febuxostat (Uloric) have failed. Perhaps your doctor sees some immediate dangers from your tophi, Kevin. Dissolving them quickly might be vital to your health. I don’t know enough about your medical history to understand the urgency. An alternative is maximum dose allopurinol.