The aim of this review is to present current evidence about the efficacy and safety of
lesinurad in combination with
xanthine oxidase inhibitors (XOIs) in the treatment of
hyperuricemia in patients with
gout.
Gout is the most common inflammatory form of
arthritis. It is caused by an elevated concentration of serum
uric acid (UA) that leads to the formation of
monosodium urate crystals in joints and different tissues. The goal of
therapy is to maintain serum UA levels at <6 mg/dL (0.36 mmol/L), to prevent the formation and deposition of
monosodium urate crystals, and to dissolve existing crystals.
Lesinurad, a new uricosuric, increases renal
urate excretion by selectively inhibiting the renal
uric acid transporter 1 (URAT1).
Lesinurad is indicated in adults, in combination with a XOI, for the adjunctive treatment of
hyperuricemia in patients with
gout (with or without tophi) who have not achieved target serum UA levels with an adequate dose of a XOI alone. With the combination strategy, serum UA targets could be reached with the consequence of inhibiting formation of new crystals and promoting dissolution of existing crystals and, therefore, inducing improvement of outcomes such as flares and tophi. The approval of
lesinurad was based on data from three pivotal phase III studies (CLEAR 1, CLEAR 2, and CRYSTAL). These clinical studies assessed
lesinurad 200 and 400 mg doses. As only
lesinurad 200 mg/day dose was finally approved and commercialized, it will be the focus of this paper. In the pivotal clinical trials, the target serum UA level was achieved by significantly more patients in
lesinurad 200 mg plus
allopurinol group (CLEAR 1 and CLEAR 2 trials) or
lesinurad 200 mg plus
febuxostat group (CRYSTAL study) compared with patients who received either XOI alone. In these trials, the safety profile of
lesinurad 200 mg plus a XOI was comparable to
allopurinol or
febuxostat alone.
Lesinurad, in combination with a XOI, is an effective and safe treatment that covers unmet needs in adults with
gout who have not achieved target serum UA levels with a XOI alone.