Emerging treatments
Arhalofenate
Arhalofenate, a novel anti-inflammatory and uricosuric agent that inhibits the anion exchanger URAT1. In a 12-week phase 2B study, arhalofenate decreased gout flares significantly compared with allopurinol.[128] However, some elements of study design deviated from routine clinical practice, such as initiating allopurinol at a higher dose than usual. Results from a small open-label phase 2 study suggest that the combination of arhalofenate and febuxostat reduces serum uric acid level to a greater extent than either drug alone.[129] The combination appeared to be safe and well tolerated.
Pegloticase plus methotrexate
Pegloticase has also been granted approval by the US Food and Drug Administration for the treatment of chronic gout in adults refractory to conventional therapy, in combination with methotrexate. The approval is based on one open-label trial which demonstrated that combination treatment of pegloticase plus methotrexate increased the proportion of patients who maintained therapeutic response at 6 months compared with pegloticase alone.[130]
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