Lesinurad combination therapy with allopurinol in gout: do CLEAR studies make the treatment of gout clearer?

What is the Place for Uricosuric Agents in Gout Management?

“…Still, in both CLEAR studies, lesinurad resulted in higher rates of (in most cases reversible) elevations in the serum creatinine level, particularly with lesinurad 400 mg. The combination of allopurinol 300 and lesinurad 200 mg reduced sUA <6.0 mg/dl in 55.4% cases at month 6; however, it was 66% with lesinurad 400-allopurinol 300 preparation [21]. Besides, febuxostat 80 mg -lesinurad 200 achieved target sUA of <5.0 mg/dl at 6-month in 56.6%, hardly different from febuxostat 80 mg only (46.8%) [20].…”

“…For that reason, we decided to summarize the newest insights. Table 1 [18][19][20][21][22][25][26][27][28][29][30] enlists research on new uricosuric agents [18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Lesinurad combination therapy with allopurinol in gout: do CLEAR studies make the treatment of gout clearer?

“…In his recent editorial commenting on the Combining Lesinurad with Allopurinol in Inadequate Responders studies,1 Dr Singh provides a thorough overview of the phase 3 trials demonstrating the efficacy and safety of lesinurad given in combination with allopurinol for the treatment of gout in patients who do not reach serum uric acid goal on allopurinol alone. We would like to thank Dr Singh for his thoughtful and balanced commentary.…”

Response to: ’A response to Singh. “Lesinurad combination therapy with allopurinol in gout: do CLEAR studies make the treatment of gout clearer?”' by Valiyil and Schechter

“…I thank Valiyil and Schechter for their letter1 to the editorial related to clinical studies of lesinurad 2. The letter correctly states that the 200 mg lesinurad dose is the only (initial and maximum) dose that should be prescribed to patients, always in combination with a xanthine oxidase inhibitor.…”

“…Based on higher toxicity, the sponsor did not pursue regulatory approval (Food and Drug Administration (FDA) and European Medicines Agency (EMEA)) for the 400 mg lesinurad dose in combination with a xanthine oxidase inhibitor. In the editorial,2 I offered caution and the need for careful monitoring when considering the use of lesinurad at the higher dose, that is, 400 mg in combination with xanthine oxidase inhibitor 3 4. Although not approved by the regulatory agencies, such use might rarely occur in clinical practice, based on an individual’s situation.…”