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Review
. 2016 Aug;8(4):145-59.
doi: 10.1177/1759720X16646703. Epub 2016 May 2.

Treatment of hyperuricemia in gout: current therapeutic options, latest developments and clinical implications

Sebastian E Sattui  1 , Angelo L Gaffo  2
Affiliations
Review

Treatment of hyperuricemia in gout: current therapeutic options, latest developments and clinical implications

Sebastian E Sattui et al. Ther Adv Musculoskelet Dis. 2016 Aug.

Abstract

Despite being the most common type of inflammatory arthritis, gout is often poorly managed. Except for febuxostat and pegloticase, research in new therapeutic agents for the management of hyperuricemia in gout remained insufficient for several decades. With emerging evidence of possible roles of hyperuricemia in cardiometabolic comorbidities, as well as more convincing evidence regarding poor outcomes (e.g. disability, recurrent hospital admissions) in patients with uncontrolled gout, several agents are current under development. Increasing knowledge regarding renal urate transporters has resulted in the development of new generation uricosurics such as lesinurad and arhalofenate. This review aims at discussing current therapeutic strategies for gout, as well as their limitations and the possible role of emerging agents in the chronic management of hyperuricemia in gout. Drugs in phases I and II of development will be discussed, along with new agents and therapeutic classes, such as purine nucleoside phosphorylase inhibitors and dual-action drugs. These new developments are encouraging, and will hopefully contribute to a more adequate management of hyperuricemia in gout.

Keywords: URAT1; arhalofenate; gout; hyperuricemia; lesinurad; ulodesine; urate-lowering therapy.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Uric acid pathway and action site of urate-lowering therapies. *Drugs in italics are agents still under development or still not approved. **Dashed arrow representing lack of metabolic step in humans, due to evolutionary loss of uricase enzyme. PNP, purine nucleoside phosphorylase; XO, xanthine oxidase.
Figure 2.
Figure 2.
Renal anion transporters involved in urate reabsorption in the proximal tubule and action sites of existing and novel uricosuric agents. *Drugs in italics are agents still under development or still not approved. GLUT, glucose transporter; OAT, organic anion transporter; URAT, urate transporter. Adapted from Rees, F. et al. (2014) Nat Rev Rheumatol 10: 271–283.
See this image and copyright information in PMC

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