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How KRYSTEXXA Works

How KRYSTEXXA Works

KRYSTEXXA is an infused biologic that converts
urate into allantoin.1

Artist's rendition of KRYSTEXXA mechanism of action, displaying that only 10% of uric acid filtered through the kidneys is excreted while nearly all of allantoin filtered through the kidneys is excreted

Artist's rendition of KRYSTEXXA mechanism of action, displaying that only 10% of uric acid filtered through the kidneys is excreted while nearly all of allantoin filtered through the kidneys is excreted

Administering methotrexate, an immunomodulator, with KRYSTEXXA can reduce immunogenicity4*

When some patients receive a biologic, their immune system may see the drug as a foreign threat and develop antidrug antibodies (ADAs).4-6

ADAs can stop the biologic from working and lead to increased risk of infusion reactions.1

Giving an immunomodulator along with the biologic can reduce ADA formation. This should reduce the risk of infusion reactions and may improve patient response.1,4

Letting your patients
know what to expect
during treatment

An everyday analogy may be a helpful way to explain to your patients how KRYSTEXXA dissolves crystal buildup within the body.
IMAGINE A SNOWY DAY…

Urate crystals build up over time in your body, similar to how snow collects on the sidewalk7,8

KRYSTEXXA is an enzyme that helps urate crystals dissolve, similar to how salt melts snow1,3

Dissolved urate crystals leave the body through the urine, similar to how melted snow flows down a drain1,3

This is a visual illustration of how KRYSTEXXA works over multiple treatments. Results may vary.

KRYSTEXXA Treatment

Giving your patients an overview of KRYSTEXXA treatment
Expand AllCollapse All
  • It’s not a medication patients will take for the rest of their lives
  • The optimal treatment duration for KRYSTEXXA has not been established; best results were seen at 6-12 months1
  • 4 weeks prior to treatment initiate 15 mg methotrexate once weekly with 1 mg folic acid daily
  • Administer 8 mg of KRYSTEXXA as an intravenous infusion every 2 weeks
  • Continue 15 mg methotrexate once weekly with 1 mg folic acid daily throughout treatment with KRYSTEXXA
  • Confirm the patient has normal G6PD activity and has discontinued other urate-lowering therapies†
  • Perform sUA test prior to each infusion to ensure sUA <6 mg/dL
  • Confirm sUA level was tested, preferably in the last 48 hours
  • Administer pretreatment medications per prescribing orders of the doctor
  • 2-hour infusion (minimum)
  • Observation of patients for approximately an hour postinfusion should be considered
  • Remind patients of their next sUA test, upcoming infusion appointments, and any premedications they should continue taking, including corticosteroids, antihistamines, 15 mg methotrexate once weekly with 1 mg folic acid daily
  • Best results for KRYSTEXXA with methotrexate were seen at 6-12 months of treatment1
  • The optimal treatment duration has not been established
  • In the clinical trial, common side effects seen in ≥5% of patients were
    • Gout flares
    • Arthralgia
    • COVID-19
    • Nausea
    • Fatigue

*KRYSTEXXA alone may be used in patients for whom methotrexate is contraindicated or not clinically appropriate.

†G6PD deficiency is an abnormally low level of glucose-6-phosphate dehydrogenase. Patients of African, Mediterranean, and Southern Asian ancestry have a higher risk of G6PD deficiency.

G6PD, glucose-6-phosphate dehydrogenase; sUA, serum uric acid. 

Efficacy

KRYSTEXXA with methotrexate can reduce sUA levels1‡

KRYSTEXXA with methotrexate provided >80% relative improvement in patient response during Month 6 and 94% relative improvement during Month 121

Seventy-one percent of patients receiving KRYSTEXXA with methotrexate (n=71/100) met the primary endpoint and reduced their sUA to <6 mg/dL for at least 80% of the time during Month 6 vs 39% of patients receiving KRYSTEXXA alone (n=20/52)1

‡A multicenter, randomized double-blind trial of KRYSTEXXA with methotrexate vs KRYSTEXXA alone in adult subjects with uncontrolled gout.

sUA, serum uric acid.

KRYSTEXXA with methotrexate can help resolve tophi1

KRYSTEXXA with methotrexate improved tophi resolution by 74%1§

Fifty-four percent of patients (n=28/52) had complete resolution of at least 1 target tophus, with no new or progressive tophi, within the first year vs 31% (n=9/29) receiving KRYSTEXXA alone1

A series of DECT scans showing urate dissolution from baseline to Month 12

A series of DECT scans showing urate dissolution from baseline to Month 12

KRYSTEXXA can change the course of uncontrolled gout by dissolving years of systemic urate deposition.10,11

Green areas represent urate crystal buildup. Best results for KRYSTEXXA with methotrexate were seen at 6-12 months of treatment.1 The optimal treatment duration has not been established.1

§Among patients with digital photography of tophi at baseline; 53.3% of patients had tophi at baseline (total), n=81.1

Patient Profiles

Learn about:

  • LINDA
  • JAMES

Meet Linda, a patient you may see in your practice

Patient Name:

Linda, 55

Occupation:

Accountant

Actor portrayal, not actual patient.
Patient history icon

Patient History

  • Diagnosed 4 years ago
  • Family has a history of gout
  • Flares: multiple flares in the last year
  • Tophi: 1 small, bothersome tophus on her hand
  • Comorbidities: hypertension

KRYSTEXXA is not indicated for the treatment of pain.

BMI, body mass index; BP, blood pressure; G6PD, glucose-6-phosphate dehydrogenase; QD, every day; sUA, serum uric acid.

Laboratory Workup

sUA level:

8.2 mg/dL

G6PD:

normal

BMI:

29

BP:

128/80

Treatment history icon Current Treatment

Allopurinol:

300 mg QD (for the past year)

Losartan:

50 mg QD

Flare Medication

Colchicine:

0.6 mg QD

Patient Background
  • Linda has been on treatment for some time, but she feels the disease just isn’t getting any better. Linda has missed work due to her disease, and even when present, the pain and distraction have made her much less efficient. While her tophus is small, it’s caused increased mental and emotional strain

KRYSTEXXA is not indicated for the treatment of pain.

BMI, body mass index; BP, blood pressure; G6PD, glucose-6-phosphate dehydrogenase; QD, every day; sUA, serum uric acid.

Meet James, a patient you may see in your practice

Actor portrayal of gout patient, James

Patient Name:

James, 52

Occupation:

Middle school teacher

Actor portrayal, not actual patient.
Patient history icon

Patient History

  • Has been seeing a primary care physician for gout for the last 15 years—his disease has rapidly progressed
  • Flares: 6 in the last year
    •  3 mitigated with flare prophylaxis
    •  2 resulted in urgent care visits
    •  1 mitigated with a cortisone injection
  • Tophi: tophi on his hands, feet, specifically ankle and MTP joint, and elbows
  • Comorbidities: diabetes

KRYSTEXXA is not indicated for the treatment of pain.

A1C, glycated hemoglobin; BID, twice daily; BMI, body mass index; G6PD, glucose-6-phosphate dehydrogenase; MTP, metatarsophalangeal; QD, every day; sUA, serum uric acid.

Laboratory Workup

sUA level:

9.3 mg/dL

G6PD:

normal

BMI:

31

A1C:

7.3%

Treatment history icon Current Treatment

Allopurinol:

300 mg QD (for the past year)

Metformin:

850 mg QD

Linagliptin:

5 mg QD

Flare Medication

Colchicine:

0.6 mg QD for prophylaxis

Naproxen:

500 mg BID

Patient Background
  • Uncontrolled gout has affected James’s ability to present in class and educate his students due to an increase in gout flares
  • Tophi growth has caused him to feel self-conscious when students talk about his “bumpy hands”
  • James has been absent from work every few months due to heightened flare pain in his feet and difficulty moving around. This has made him nervous about job security, resulting in financial worry

KRYSTEXXA is not indicated for the treatment of pain.

A1C, glycated hemoglobin; BID, twice daily; BMI, body mass index; G6PD, glucose-6-phosphate dehydrogenase; MTP, metatarsophalangeal; QD, every day; sUA, serum uric acid.

KRYSTEXXA can help real patients get their gout back under control

Before & After KRYSTEXXA With Methotrexate

Real KRYSTEXXA patient, Bet

REAL PATIENT

Patient name/age:

Occupation:

Stay-at-home parent

The ACR Guidelines STRONGLY RECOMMEND pegloticase for patients like Bet12

KRYSTEXXA can be coadministered with methotrexate1

Patient history icon

Patient History

  • A father and husband who loves spending time with his children
  • Has had gout for over 20 years
  • Stopped working construction due to pain and limited mobility
  • No known comorbidities

Physical & Lab Evaluation

Before

  • sUA level: 10.4 mg/dL
  • BMI: 38.5
  • Tophi: Visible tophi
  • Swollen/tender joints: Chronic pain in multiple joints
  • Flares: >2/year

After

  • sUA level: <1 mg/dL
  • Tophi: Reduced
  • Functional Status: Can walk and perform daily activities

Treatment History

Before

  • Allopurinol: 7 years with increasing doses
  • Colchicine: 7 years while flaring
  • Febuxostat: 1 year

BEFORE

Enlarge

After

  • Colchicine: 0.6 mg as needed
  • Methotrexate: 15 mg orally per week
  • KRYSTEXXA: 8 mg every 2 weeks

AFTER

Enlarge

Best results were seen at 6-12 months.1 Optimal treatment duration has not been established.1 Individual results may vary.

Best results were seen at 6-12 months.1 Optimal treatment duration has not been established.1 Individual results may vary.

“I wish I had started KRYSTEXXA (with methotrexate) sooner. Now, I go out and do things and not just want to stay at home. I’m definitely in a better place now.”

0:00 / 0:00

KRYSTEXXA is not indicated for the treatment of pain.

ACR, American College of Rheumatology; BMI, body mass index; sUA, serum uric acid.

KRYSTEXXA can help real patients get their gout back under control

Before & After KRYSTEXXA With Methotrexate

Real KRYSTEXXA patient, Michael
REAL PATIENT
Patient name/age:
Occupation:
Architect

Patient History

  • Loves spending time with his wife and 4 children, though gout kept them from traveling as much as they’d like
  • 30-year history of gout
  • Frequent flares in his hands and feet were so painful, he kept a set of crutches in his car at all times
  • Could not tolerate allopurinol; took colchicine and indomethacin for pain, but still had flares and tophi
  • A nephrologist was the key to Michael’s success. It wasn’t until his nephrologist told him about KRYSTEXXA and took the lead in managing his uncontrolled gout, that things began to change

Physical & Lab Evaluation

Before

  • sUA level: 10.3 mg/dL
  • Tophi: Visible tophi
  • Flares: 1-2/month
  • Swollen, tender joints: Chronic pain in multiple joints

After

  • sUA level: 1.5 mg/dL
  • Tophi: 1 completely resolved, others reduced
  • Functional Status: Can walk, perform most daily activities, and is back to planning trips with his family

Treatment History

Before

  • Allopurinol: Discontinued due to side effects
  • Colchicine: As needed during flares
  • Uloric: Discontinued due to side effects

Enlarge

After

  • Colchicine: As needed
  • KRYSTEXXA: 8 mg every 2 weeks
  • Methotrexate: 15 mg orally per week

Enlarge

Best results were seen at 6-12 months.1 Optimal treatment duration has not been established.1 Individual results may vary.

Best results seen at 6-12 months.1 Optimal treatment duration has not been established.1 Individual results may vary.

“KRYSTEXXA gave me hope. Without my nephrologist’s confidence and determination to help me, I would never have gotten my gout under control.”

0:00 / 0:00

sUA, serum uric acid.

IMPORTANT SAFETY INFORMATION

WARNING: ANAPHYLAXIS AND INFUSION REACTIONS, G6PD DEFICIENCY ASSOCIATED HEMOLYSIS AND METHEMOGLOBINEMIA

  • Anaphylaxis and infusion reactions have been reported to occur during and after administration of KRYSTEXXA.
  • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within 2 hours of the infusion. Delayed hypersensitivity reactions have also been reported.
  • KRYSTEXXA should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions.
  • Premedicate with antihistamines and corticosteroids and closely monitor for anaphylaxis for an appropriate period after administration of KRYSTEXXA.
  • Monitor serum uric acid levels prior to each infusion and discontinue treatment if levels increase to above 6 mg/dL, particularly when 2 consecutive levels above 6 mg/dL are observed.
  • Screen patients at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to starting KRYSTEXXA. Hemolysis and methemoglobinemia have been reported with KRYSTEXXA in patients with G6PD deficiency. KRYSTEXXA is contraindicated in patients with G6PD deficiency.

CONTRAINDICATIONS:

  • In patients with G6PD deficiency.
  • In patients with history of serious hypersensitivity reactions, including anaphylaxis, to KRYSTEXXA or any of its components.

WARNINGS AND PRECAUTIONS

Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.

Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.

ADVERSE REACTIONS

The most commonly reported adverse reactions (≥5%) are:

KRYSTEXXA co-administration with methotrexate trial:

KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.

KRYSTEXXA pre-marketing placebo-controlled trials:

gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.

INDICATION

KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.

Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.

Please see Full Prescribing Information, including Boxed Warning.

IMPORTANT SAFETY INFORMATION

WARNING: ANAPHYLAXIS AND INFUSION REACTIONS, G6PD DEFICIENCY ASSOCIATED HEMOLYSIS AND METHEMOGLOBINEMIA

  • Anaphylaxis and infusion reactions have been reported to occur during and after administration of KRYSTEXXA.
  • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within 2 hours of the infusion. Delayed hypersensitivity reactions have also been reported.
  • KRYSTEXXA should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions.
  • Premedicate with antihistamines and corticosteroids and closely monitor for anaphylaxis for an appropriate period after administration of KRYSTEXXA.
  • Monitor serum uric acid levels prior to each infusion and discontinue treatment if levels increase to above 6 mg/dL, particularly when 2 consecutive levels above 6 mg/dL are observed.
  • Screen patients at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to starting KRYSTEXXA. Hemolysis and methemoglobinemia have been reported with KRYSTEXXA in patients with G6PD deficiency. KRYSTEXXA is contraindicated in patients with G6PD deficiency.

CONTRAINDICATIONS:

  • In patients with G6PD deficiency.
  • In patients with history of serious hypersensitivity reactions, including anaphylaxis, to KRYSTEXXA or any of its components.

WARNINGS AND PRECAUTIONS

Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.

Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.

ADVERSE REACTIONS

The most commonly reported adverse reactions (≥5%) are:

KRYSTEXXA co-administration with methotrexate trial:

KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.

KRYSTEXXA pre-marketing placebo-controlled trials:

gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.

INDICATION

KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.

Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.

Please see Full Prescribing Information, including Boxed Warning.

  • KRYSTEXXA (pegloticase) [prescribing information] Horizon.
  • Terkeltaub R, et al. Arthritis Res Ther. 2006;8(suppl 1):S4.
  • McDonagh EM, et al. Pharmacogenet Genomics. 2014;24:464-476.
  • Keenan RT, et al. Semin Arthritis Rheum. 2021;51:347-352.
  • Yun H, et al. Arthritis Care Res (Hoboken). 2017;69:1526-1534.
  • Cohen R, et al. J Pediatr Gastroenterol Nutr. 2019;69:551-556.
  • Schett G, et al. RMD Open. 2015;1(suppl 1):e000046.
  • Doghramji PP, et al. Postgrad Med. 2012;124:98-109.
  • Keenan RT, et al. Rheumatol Ther. 2019;6:299-304.
  • Sundy JS, et al. JAMA. 2011;306:711-720.
  • Schlesinger N, et al. Arthritis Rheumatol. 2017;69(suppl 10):1-4426.
  • FitzGerald JD, et al. Arthritis Care Res (Hoboken). 2020;72:744-760.