Krystexxa is a PEGylated uric acid specific enzyme that is sometimes used in the treatment of chronic gout in adults who are not responding to other conventional treatments.
Patients who fail to respond to xanthine oxidase blockers or in whom serum uric acid level is not normalized with conventional therapy may be given Krystexxa. Genetically modified E.coli produces the enzyme. Krystexxa catalyzes the oxidation of uric acid to allantoin, which is water soluble and is easily removed through urine.
• 8mg/ml pegloticase in a phosphate-buffered saline
Usually doctors prescribe one dose (8mg) of Krystexxa every 2 weeks or 4 weeks depending on uric acid levels in blood. This needs to be given as an intravenous infusion over no less than 120 minutes via gravity feed, syringe type pump or infusion pump. A healthcare provider should administer this drug in a health care setting, so that they can be prepared to deal with anaphylaxis or infusion reactions, if they occur. They will also need to monitor the patient after administering the dose and keep a close check on serum uric acid levels.
Possible Side Effects
There are many serious side effects associated with this treatment. These include gout flares (in about 77% cases), infusion reactions (patients should be pre-medicated with antihistamines and corticosteroids before giving Krystexxa), anaphylaxis in 5% of the patients and heart failure in patients with a pre-existing heart condition. Less serious side effects include nausea, contusion, nasopharyngitis, constipation, chest pain, and vomiting. It is also contraindicated for use in patients with a Glucose-6-phosphate dehydrogenase Deficiency. It should not be used in individuals below 18 years of age.
The price per dose is a whopping $5,390.
The FDA has recently approved this treatment for gout and gouty arthritis.
Krystexxa Overall Value
This drug should be taken only when prescribed by a physician and only in a hospital setting. It is an extremely expensive treatment and has many serious side effects. It is however, covered under some insurance policies as long as certain conditions are met.
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