A 52-year-old man with long-standing gout and visible tophi on both elbows has serum urate of 9.4 mg/dL despite allopurinol 300 mg/day. He has eGFR of 55 mL/min and is intolerant of febuxostat. Which agent is specifically approved for refractory gout with inadequate response to xanthine oxidase inhibitors?
- A Rasburicase
- B Probenecid
- C Pegloticase (PEGylated recombinant uricase) ✓
- D Benzbromarone
Correct answer: C. Pegloticase (PEGylated recombinant uricase)
Explanation
Pegloticase is a PEGylated recombinant uricase approved for refractory chronic tophaceous gout unresponsive to conventional urate-lowering therapy. It converts urate to allantoin (which is water-soluble and easily excreted), dramatically lowering serum urate. Rasburicase is used for tumour lysis syndrome, not chronic gout. Probenecid and benzbromarone are uricosuric agents that may be added to allopurinol but are not indicated for refractory tophaceous disease when xanthine oxidase inhibitors have failed.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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