You are here

Article Text

Article menu

Download PDFPDF

Editorial
Lesinurad combination therapy with allopurinol in gout: do CLEAR studies make the treatment of gout clearer?
Free
  1. Jasvinder A Singh1,2,3
  1. 1Birmingham VA Medical Center, Birmingham, Alabama, USA
  2. 2Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Jasvinder A Singh, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA; Jasvinder.md{at}gmail.com

https://doi.org/10.1136/annrheumdis-2016-210519

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Gout is an often forgotten disease,1 despite being the most common inflammatory arthritis in adults in the Western world.2–4 Lesinurad, a new urate-lowering therapy (ULT), is now approved for the treatment of gout in the USA and the European Union,5 ,6 and is in phase III programmes as a combination therapy in many other countries. Lesinurad is a selective inhibitor of urate/anion exchanger 1 and organic acid transporter 4, two urate transporters responsible for the reabsorption of urate from the proximal renal tubule.7 Probenecid and benzbromarone are the other uricosurics available for use in gout as monotherapy or combination with allopurinol in case of an inadequate response to allopurinol. In the current issue of the journal, Bardin et al present the results of a 12-month, randomised, phase III trial efficacy and safety of oral lesinurad (200 or 400 mg) in combination with allopurinol.8 Combining Lesinurad with Allopurinol in Inadequate Responders (CLEAR) were two replicate studies, one in the USA (CLEAR-1)9 and one in Europe (CLEAR-2), published in the current issue of this journal.8 CLEAR-2 compared daily lesinurad (200 or 400 mg orally) with placebo when added to allopurinol in 610 patients with gout with serum uric acid (sUA) above target (<6 mg/dL or <0.36 mmol/L) and frequent gout flares (≥2 gout flares in the prior year).

    What did the CLEAR-2 trial results show?

    The primary trial endpoint of sUA <6 mg/dL (ie, <0.36 mmol/L) at 6 months was achieved by a significantly greater proportion of patients, 55% and 66% in the lesinurad 200 mg+allopurinol and lesinurad 400 mg+allopurinol groups versus 23% in the allopurinol alone group (p<0.0001 vs either lesinurad group).8 These rates were similar to the achievement of target sUA <6 mg/dL (ie, <0.36 mmol/L) in CLEAR-1.9 To my knowledge, CLEAR-28 and the replicate study, CLEAR-1,9 are the two largest randomised control trials …

    View Full Text

    Linked Articles