The combination of methotrexate and pegloticase may be safe and effective for patients with uncontrolled gout, according to a new study published by Botson et al in ACR Open Rheumatology. In the MIRROR RCT trial, researchers randomly assigned patients 2:1 to receive either 15 mg of oral methotrexate weekly plus 8 mg of pegloticase once every 2 weeks, or placebo plus pegloticase. The primary endpoints were the proportion of responders to the combination therapy at 6, 9, and 12 months; resolution of at least one tophi; mean serum urate reduction; and time to discontinuation of pegloticase. After a follow-up of 12 months, patients who received methotrexate and pegloticase demonstrated response rates of 60.0% vs 30.8% among those who received placebo plus pegloticase; discontinuation rates of 22.9% vs 63.3%, and tophi resolution rates of 53.8% vs 31.0%. The researchers concluded that methotrexate plus pegloticase therapy may increase response in patients with uncontrolled gout.
July 07, 2023