Chronic Uncontrolled Gout, Gout, Uncontrolled Gout
Conditions
Keywords
gout, uncontrolled gout
Brief summary
The purpose of this study is to assess the safety, tolerability and efficiency of pegloticase administered with a shorter infusion duration in participants with uncontrolled gout receiving methotrexate.
Detailed description
Approximately 180 participants will be enrolled. After a 4-week methotrexate run-in period, participants will be treated for up to 24 weeks with weekly oral methotrexate and biweekly 8mg pegloticase infusions. Up to three pegloticase infusion durations will be assessed in the study: 60-minute infusion, 45-minute infusion and 30-minute infusion. Safety evaluations will be performed regularly throughout the course of the study. Acquired from Horizon in 2024.
Interventions
Participants will receive MTX during the run-in period then pegloticase with MTX for up to 24 weeks during the treatment period
Sponsors
Study design
Intervention model description
Three different infusion durations may be used. 60-minute infusion, 45-minute infusion and 30-minute.
Eligibility
Inclusion criteria
1. Adult men or women ≥18 years of age. 2. Uncontrolled gout, defined as meeting the following criteria: * Hyperuricemia during the screening period defined as sUA ≥6 mg/dL * Failure to maintain normalization of sUA with xanthine oxidase inhibitors at the maximum medically appropriate dose, or with intolerable side effects or a contraindication to xanthine oxidase inhibitor therapy based on medical record review or subject interview. * Symptoms of gout including at least 1 of the following: * Presence of at least one tophus * Recurrent flares defined as 2 or more flares in the past 12 months prior to screening * Presence of chronic gouty arthritis 3. Willing to discontinue all oral urate-lowering therapy at least 7 days prior to MTX dosing at Week -4 and remain off of urate lowering therapy when receiving pegloticase infusions during the study.
Exclusion criteria
1. Severe chronic or recurrent bacterial infections, such as recurrent pneumonia or chronic bronchiectasis. 2. Current or chronic treatment with systemic immunosuppressive agents such as MTX, azathioprine, or mycophenolate mofetil; prednisone ≥10 mg/day or equivalent dose of other corticosteroid on a chronic basis (defined as 3 months or longer) would also meet
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Experienced an Infusion Reaction (IR), Including Anaphylaxis, Related to Pegloticase From Day 1 to Week 24 | Day 1 to Week 24 | IRs, including anaphylaxis, were assessed after each infusion for a period of 24 weeks. IRs were defined as any infusion-related adverse event (AE) or cluster of temporally-related AEs, not attributable to another cause, which occurred during the pegloticase infusion and up to 2 hours post-infusion. Additional AEs occurring outside of the 2-hour window following infusion could also be categorized as an IR at the Principal Investigator's discretion. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Serum Uric Acid (sUA) Responders at Month 6 | Up to 6 months | Responders were defined as participants who achieved and maintained sUA levels below 6 mg/dL for at least 80% of the time during month 6. Responders who met sUA discontinuation criteria (2 consecutive sUA \> 6 mg/dL), regardless of treatment status were considered non-responders. |
| Percentage of Participants Who Experienced an IR Leading to Discontinuation of Treatment, Anaphylaxis or Met sUA Discontinuation Criteria | Day 1 to Week 24 | IRs were defined as any infusion-related AE or cluster of temporally-related AEs, not attributable to another cause, which occurred during the pegloticase infusion and for 2 hours post-infusion. Other AEs that occurred outside of the 2 hour window following the infusion may have also been categorized as an IR at the Principal Investigator's discretion. Anaphylaxis was defined using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. Meeting individual sUA discontinuation criteria was defined as two consecutive pre-infusion sUAs \> 6 mg/dL after Day 1. |
| Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in All Participants | Day 1 to Week 24 | Infusion reactions were defined as any infusion-related adverse event or cluster of temporally-related adverse events, not attributable to another cause, which occurred during the infusion and for 2 hours post-infusion. Other adverse events that occurred outside of the 2-hour window following the infusion may have also been categorized as an infusion reaction at the Principal Investigator's discretion. Anaphylaxis was defined using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. Meeting individual serum uric acid discontinuation criteria was defined as two consecutive pre-infusion serum uric acid levels greater than 6 mg/dL after Day 1. Time to event was derived as the date of the event minus the date of the first dose of the treatment plus 1. All participants were censored at the date of their last infusion. |
| Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in Participants With an Event | Day 1 to Week 24 | IRs were defined as any infusion-related adverse event or cluster of temporally-related adverse events, not attributable to another cause, which occurred during the infusion and for 2 hours post-infusion. Other adverse events that occurred outside of the 2-hour window following the infusion may have also been categorized as an infusion reaction at the Principal Investigator's discretion. Anaphylaxis was defined using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. Meeting individual serum uric acid discontinuation criteria was defined as two consecutive pre-infusion serum uric acid levels greater than 6 mg/dL after Day 1. Time to event was derived as the date of the event minus the date of the first dose of the treatment plus 1. Only participants who experienced an event were included in this analysis. |
Countries
United States
Participant flow
Recruitment details
Participants with uncontrolled gout were enrolled at 36 centers across the United States between October 2020 and March 2024.
Pre-assignment details
A 4-week methotrexate (MTX) run-in period, with a weekly dose of 15 mg, was used to identify screening failures due to MTX intolerance. All participants who completed the run-in period received their first dose of pegloticase on Day 1, followed by additional doses every 2 weeks (Q2W) for a total of 22 weeks.
Participants by arm
| Arm | Count |
|---|---|
| Pegloticase 60 Minute + MTX Participants received oral MTX (15 mg) (weekly) during the Run-in Period, then 60-minute pegloticase IV infusions (every 2 weeks) with MTX (weekly) for 24 weeks. | 116 |
| Pegloticase 45 Minute + MTX Participants received oral MTX (15 mg) (weekly) during the Run-in Period, then 45-minute pegloticase IV infusions (every 2 weeks) with MTX (weekly) for 24 weeks. | 13 |
| Pegloticase 30 Minute + MTX Participants received oral MTX (15 mg) (weekly) during the Run-in Period, then 30-minute pegloticase IV infusions (every 2 weeks) with MTX (weekly) for 24 weeks. | 62 |
| Total | 191 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 3 | 0 | 4 |
| Overall Study | Withdrawal by Subject | 17 | 1 | 8 |
Baseline characteristics
| Characteristic | Total | Pegloticase 30 Minute + MTX | Pegloticase 45 Minute + MTX | Pegloticase 60 Minute + MTX |
|---|---|---|---|---|
| Age, Continuous | 56.2 Years STANDARD_DEVIATION 11.2 | 56.9 Years STANDARD_DEVIATION 11.04 | 61.1 Years STANDARD_DEVIATION 9.96 | 55.2 Years STANDARD_DEVIATION 11.33 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 11 Participants | 2 Participants | 1 Participants | 8 Participants |
| Race/Ethnicity, Customized Black or African American | 30 Participants | 9 Participants | 3 Participants | 18 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 34 Participants | 4 Participants | 1 Participants | 29 Participants |
| Race/Ethnicity, Customized More than 1 race | 4 Participants | 1 Participants | 0 Participants | 3 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Not Hispanic or Latino | 157 Participants | 58 Participants | 12 Participants | 87 Participants |
| Race/Ethnicity, Customized Other | 3 Participants | 0 Participants | 0 Participants | 3 Participants |
| Race/Ethnicity, Customized White | 141 Participants | 48 Participants | 9 Participants | 84 Participants |
| Sex: Female, Male Female | 23 Participants | 9 Participants | 2 Participants | 12 Participants |
| Sex: Female, Male Male | 168 Participants | 53 Participants | 11 Participants | 104 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 215 | 0 / 116 | 0 / 13 | 0 / 62 |
| other Total, other adverse events | 79 / 215 | 86 / 116 | 13 / 13 | 46 / 62 |
| serious Total, serious adverse events | 1 / 215 | 4 / 116 | 0 / 13 | 5 / 62 |
Outcome results
Percentage of Participants Who Experienced an Infusion Reaction (IR), Including Anaphylaxis, Related to Pegloticase From Day 1 to Week 24
IRs, including anaphylaxis, were assessed after each infusion for a period of 24 weeks. IRs were defined as any infusion-related adverse event (AE) or cluster of temporally-related AEs, not attributable to another cause, which occurred during the pegloticase infusion and up to 2 hours post-infusion. Additional AEs occurring outside of the 2-hour window following infusion could also be categorized as an IR at the Principal Investigator's discretion.
Time frame: Day 1 to Week 24
Population: Safety Analysis Set (SAS): All participants who received at least 1 dose of pegloticase.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pegloticase 60 Minute + MTX | Percentage of Participants Who Experienced an Infusion Reaction (IR), Including Anaphylaxis, Related to Pegloticase From Day 1 to Week 24 | 6.0 Percentage of Participants |
| Pegloticase 45 Minute + MTX | Percentage of Participants Who Experienced an Infusion Reaction (IR), Including Anaphylaxis, Related to Pegloticase From Day 1 to Week 24 | 0 Percentage of Participants |
| Pegloticase 30 Minute + MTX | Percentage of Participants Who Experienced an Infusion Reaction (IR), Including Anaphylaxis, Related to Pegloticase From Day 1 to Week 24 | 12.9 Percentage of Participants |
Percentage of Participants Who Experienced an IR Leading to Discontinuation of Treatment, Anaphylaxis or Met sUA Discontinuation Criteria
IRs were defined as any infusion-related AE or cluster of temporally-related AEs, not attributable to another cause, which occurred during the pegloticase infusion and for 2 hours post-infusion. Other AEs that occurred outside of the 2 hour window following the infusion may have also been categorized as an IR at the Principal Investigator's discretion. Anaphylaxis was defined using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. Meeting individual sUA discontinuation criteria was defined as two consecutive pre-infusion sUAs \> 6 mg/dL after Day 1.
Time frame: Day 1 to Week 24
Population: SAS: All participants who received at least 1 dose of pegloticase.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pegloticase 60 Minute + MTX | Percentage of Participants Who Experienced an IR Leading to Discontinuation of Treatment, Anaphylaxis or Met sUA Discontinuation Criteria | 19.0 Percentage of Participants |
| Pegloticase 45 Minute + MTX | Percentage of Participants Who Experienced an IR Leading to Discontinuation of Treatment, Anaphylaxis or Met sUA Discontinuation Criteria | 7.7 Percentage of Participants |
| Pegloticase 30 Minute + MTX | Percentage of Participants Who Experienced an IR Leading to Discontinuation of Treatment, Anaphylaxis or Met sUA Discontinuation Criteria | 32.3 Percentage of Participants |
Percentage of Serum Uric Acid (sUA) Responders at Month 6
Responders were defined as participants who achieved and maintained sUA levels below 6 mg/dL for at least 80% of the time during month 6. Responders who met sUA discontinuation criteria (2 consecutive sUA \> 6 mg/dL), regardless of treatment status were considered non-responders.
Time frame: Up to 6 months
Population: mITT Analysis Set: All participants who received at least 1 dose of pegloticase.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pegloticase 60 Minute + MTX | Percentage of Serum Uric Acid (sUA) Responders at Month 6 | 67.2 Percentage of Participants |
| Pegloticase 45 Minute + MTX | Percentage of Serum Uric Acid (sUA) Responders at Month 6 | 76.9 Percentage of Participants |
| Pegloticase 30 Minute + MTX | Percentage of Serum Uric Acid (sUA) Responders at Month 6 | 56.5 Percentage of Participants |
Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in All Participants
Infusion reactions were defined as any infusion-related adverse event or cluster of temporally-related adverse events, not attributable to another cause, which occurred during the infusion and for 2 hours post-infusion. Other adverse events that occurred outside of the 2-hour window following the infusion may have also been categorized as an infusion reaction at the Principal Investigator's discretion. Anaphylaxis was defined using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. Meeting individual serum uric acid discontinuation criteria was defined as two consecutive pre-infusion serum uric acid levels greater than 6 mg/dL after Day 1. Time to event was derived as the date of the event minus the date of the first dose of the treatment plus 1. All participants were censored at the date of their last infusion.
Time frame: Day 1 to Week 24
Population: SAS: All participants who received at least 1 dose of pegloticase.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pegloticase 60 Minute + MTX | Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in All Participants | NA Days |
| Pegloticase 45 Minute + MTX | Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in All Participants | NA Days |
| Pegloticase 30 Minute + MTX | Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in All Participants | NA Days |
Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in Participants With an Event
IRs were defined as any infusion-related adverse event or cluster of temporally-related adverse events, not attributable to another cause, which occurred during the infusion and for 2 hours post-infusion. Other adverse events that occurred outside of the 2-hour window following the infusion may have also been categorized as an infusion reaction at the Principal Investigator's discretion. Anaphylaxis was defined using the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria. Meeting individual serum uric acid discontinuation criteria was defined as two consecutive pre-infusion serum uric acid levels greater than 6 mg/dL after Day 1. Time to event was derived as the date of the event minus the date of the first dose of the treatment plus 1. Only participants who experienced an event were included in this analysis.
Time frame: Day 1 to Week 24
Population: All participants who received at least 1 dose of pegloticase and experienced an IR leading to discontinuation of treatment, anaphylaxis or met sUA discontinuation criteria.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Pegloticase 60 Minute + MTX | Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in Participants With an Event | 17.0 Days |
| Pegloticase 45 Minute + MTX | Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in Participants With an Event | 15.0 Days |
| Pegloticase 30 Minute + MTX | Time to First Event of IR Leading to Discontinuation of Treatment, Anaphylaxis or Meeting sUA Discontinuation Criteria in Participants With an Event | 43.0 Days |