Pegloticase

INTRODUCTION

Indications

Treatment of chronic gout in adults who have not responded to/cannot tolerate xanthine oxidase inhibitors, including allopurinol.

Action

Consists of recombinant uricase covalently bonded to monomethoxypoly (ethylene glycol) [mPEG]); uricase catalyzes the oxidation of uric acid to allantoin, a water-soluble by-product that is readily excreted in urine. Therapeutic Effects: ↓ serum uric acid levels with resultant ↓ in attacks of gout and its sequelae.

Adverse Reactions/Side Effects

CV: chest pain. EENT: nasopharyngitis. GI: nausea, constipation, vomiting. Derm: contusion/ecchymoses. Metab: gout flare. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, INFUSION REACTIONS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for allergy-like responses that occur during and after administration (infusion related reactions). Notify physician or nursing staff immediately of any signs of hypersensitivity.

• If treating gouty arthritis, periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether drug therapy is successful. Report any increase in symptoms that occur when initiating drug therapy (gout flare).

• Monitor any chest pain and attempt to determine if pain is drug-induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise). Report severe or unexplained chest pain.

Interventions

• If treating arthritic conditions, implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of drug therapy.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged irritation of the nose or pharynx, skin reactions (contusions, bruising), and GI problems (nausea, vomiting, constipation).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Glucose-6-phosphate dehydrogenase (G6PD) deficiency (risk of hemolysis and methemoglobinemia). Lactation: Breast-feeding is not recommended.

Use Cautiously in: Congestive heart failure (may ↑ risk of exacerbation); Retreatment after a drug-free interval (↑ risk of allergic reactions, monitor carefully); Geri: Elderly patients may be more sensitive to drug effects; OB: Use during pregnancy only if clearly needed; Pedi: Safe and effective use in children <18 yr not established.

Interactions