FRI0237 Pegloticase treatment significantly decreases mean arterial blood pressure in patients with chronic gout

Background There are significant correlations between serum uric acid (sUA) and blood pressure (BP) in individuals with and without gout. 1 Limited data suggest that lowering sUA may decrease BP 2 , but no consistent effect has been noted. 3 Recent guidelines suggest the need for more aggressive management of increased BP. 4 Objectives To determine the impact of persistent, very low sUA levels on BP in subjects with chronic refractory gout treated with pegloticase, a recombinant uricase conjugated to polyethylene glycol approved for chronic refractory gout that decreases sUA to Methods This analysis used results from two, 6 month randomised clinical trials (RCTs) in which subjects were treated with 8 mg pegloticase every 2 or 4 weeks (q2w or q4w) or placebo. 5 sUA responders maintained sUA 5 Sitting BP was measured at each visit and estimated glomerular filtration rate (eGFR) was determined at baseline and after 3 and 6 months. Results Serial BP measures were obtained in 173 subjects during the course of the RCTs. Significant reductions in mean arterial pressure (MAP) from baseline to 6 months were noted in q2w responders (p=0.0029) (figure 1), whereas reductions in MAP in other groups were not significant. Notably, 18/29 (62.1%) of q2w sUA responders experienced persistent reductions in MAP (p=0.01 compared to other groups). Changes in both systolic and diastolic BP paralleled the change in MAP. Of the q2w sUA responders exhibiting persistent decreases in MAP, there were no significant differences in baseline age, gender, race, body mass index, history of hypertension, gout duration, MAP, sUA, cholesterol, eGFR, or urinary UA/creatine ratio compared with those who did not lower MAP. There were no significant changes in eGFR in sUA responders to pegloticase treatment over the course of the study and there was no significant correlation between change from baseline MAP and eGFR in these subjects (p=0.43). Conclusions Responders to biweekly pegloticase experienced significant reductions in MAP that were independent of changes in renal function. References [1] Lee JJ, et al. J Clin Hyperten 2013;15:435. [2] Agarwal V, et al. J Clin Hyperten 2013;15:435. [3] Franca GPH, et al. Cochrane Database Syst Rev. 2017;4:CD008652. [4] Whelton PK, et al. J Am Coll Cardiol2017Nov 13. [Epub ahead of print]. [5] Sundy JS, et al. JAMA2011;306:711. Disclosure of Interest H. Choi Grant/research support from: AstraZeneca, Consultant for: Horizon Pharma, Selecta, R. Johnson: None declared, A. Yeo Consultant for: Horizon Pharma, P. Lipsky Consultant for: Horizon Pharma