Pegloticase hypersensitivity desensitisation: an outpatient, 3-bag, 12-step protocol. Issue 6 (21st June 2020)

• Record Type: Journal Article
• Authors: Botson, John K
• Is Part Of: BMJ case reports. Volume 13:Issue 6(2020)
• Publication Date: 2020-06-21
• Subjects: rheumatology -- immunology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-234721
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Pegloticase is a highly effective treatment for refractory gouty arthropathy. Unfortunately, the medication is also highly immunogenic, leading to infusion reactions, loss of drug efficacy and anaphylaxis. Desensitisation, a procedure to tolerise a patient to a medication previously causing a hypersensitivity reaction, has been used successfully in oncology for chemotherapy treatment. The same principle can be applied to other specialties. Presented is a 48-year-old man who experienced multiple, severe infusion reactions to pegloticase administered for gouty arthropathy. A rapid desensitisation was performed using an outpatient, 3-bag, 12-step protocol, which allowed multiple additional pegloticase infusions to be performed without incident. This is the first reported case of a patient successfully desensitised after an infusion reaction to pegloticase. Though additional patients are needed to confirm these results, this represents a significant opportunity to recapture and continue pegloticase therapy in patients treated for refractory gouty arthropathy.