Finding a solution to out-of-control chronic gout: Khash’s story

(BPT) - At 21 years old, Khashayar (Khash) B. lived a life similar to any other young adult. He spent time going out with family and friends, going to the gym and leading an overall active lifestyle. That is, until he started noticing recurring pain in the joints in his foot. He wrote it off at first, but when the pain started becoming more frequent and severe, and began occurring in his knees and elbows, he decided to see a doctor.

What initially began as on-and-off foot pain eventually led to the diagnosis of a debilitating condition: chronic gout that had become out of control. More than 9 million Americans have gout¹ – in fact, it’s the most common type of inflammatory arthritis.² While some people can manage the disease with daily oral medications, others are affected by a chronic form of the condition and experience ongoing symptoms.

Out-of-control chronic gout is characterized by painful symptoms that can negatively impact quality of life. The most common symptoms include intense joint pain, lingering discomfort, swelling, redness and limited range of motion in joints.³ The joint pain is caused by the buildup of uric acid in the joints, which form painful crystals called tophi.⁴

Khash has been living with gout for most of his adult life. At 45 years old, he had been taking oral therapies for years and spending every day wondering when he would have relief from the pain of gout.

As a result of his constant pain, Khash was unable to make plans with his wife, Carmela, and son. Khash’s inability to participate in daily activities with his family became the norm as his gout became progressively worse.

“You’re always thinking about it – ‘I know this pain is coming and it’s only going to get worse once I start moving, but I have to move,” said Khash. Pushed to the brink by his pain, Khash realized his daily medication wasn’t working and began searching for other options.

In the summer of 2019, Khash talked with Dr. Orrin Troum, a rheumatologist who treats diseases of the joints, muscles and bones. Khash told him about the challenges gout was causing in his daily life and his greatest hope – to finally live his life without constant worry that a gout flare could derail his plans.

“Talking with Khash about his years of living with gout and his recurring flares, it was clear that his gout was not controlled,” said Troum. “Together, we came up with an approach to help Khash by addressing the problem at the heart of gout: his high levels of uric acid.” With a new plan in place, Khash was ready to start a treatment I recommended called KRYSTEXXA (pegloticase), which is an infusion therapy that targets the source of gout by lowering uric acid levels. KRYSTEXXA is not recommended if you have high levels of uric acid without a history of gout. Khash received his first infusion in June 2019, with Carmela at his side. Patients should always consult with their physicians before starting a new medication. Serious allergic reactions may happen in some patients who receive KRYSTEXXA. These allergic reactions can be life threatening and usually happen within 2 hours of the infusion. Patients should watch for any sign of allergic reaction during and after treatment with KRYSTEXXA. Common side effects of KRYSTEXXA include gout flare-ups, allergic reactions, nausea, bruising, sore throat, constipation, chest pain, and vomiting. Please read additional Important Safety Information, including Boxed Warning, at the end of this article.

In the week following the infusion, Khash continued experiencing severe gout flares, which his doctor explained may occur as an initial response. After several infusions, Khash began feeling relief from his symptoms and a noticeable decrease in flares. Though gradual, the improvement was encouraging. Khash continued with the infusion schedule because he knew KRYSTEXXA was working to lower his uric acid levels and reduce potential further damage. “I feel better. I do get gout flare-ups, but it’s not to anywhere near the same degree as it was initially, so [KRYSTEXXA] is doing its job.”

Gout flares may increase when starting KRYSTEXXA, particularly in the first 3 months. Do not stop receiving KRYSTEXXA even if you have a flare. In clinical studies, gout flares decreased after 3 months of treatment. Your doctor may give you other medicines to help reduce your gout flares after starting KRYSTEXXA.⁵

After six months of treatment, Khash’s uric acid levels had drastically decreased in response to treatment with KRYSTEXXA. Individual results of treatment with KRYSTEXXA may vary from patient to patient.

“His tophi have shrunk dramatically, he’s having less attacks of gout, and we’re both thrilled about that,” said Troum.

“I don’t wake up anticipating pain from gout – for 20 years I was dealing with this misery with fear at the end of the tunnel,” said Khash. “When my doctor recommended KRYSTEXXA, I was quick to jump on it.”

“He is back to the Khash that I met 11 years ago,” said Carmela. “He wakes up with a smile on his face – I’m feeling like I’m with my best friend again.”

To hear more real stories visit www.KRYSTEXXA.com.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about KRYSTEXXA (pegloticase)?

Serious allergic reactions may happen in some patients who receive KRYSTEXXA. These allergic reactions can be life threatening and usually happen within 2 hours of the infusion.

KRYSTEXXA should be given to you by a doctor or nurse in a healthcare setting where serious allergic reactions can be treated. Your doctor or nurse should watch you for any signs of a serious allergic reaction during and after your treatment with KRYSTEXXA.

Tell your doctor or nurse right away if you have any of these symptoms during or after your treatment with KRYSTEXXA:

• Wheezing, shortness of breath, cough, chest tightness, chest pain or trouble breathing
• Dizziness, fainting, fast or weak heartbeat or feeling nervous
• Reddening of the face, itching, hives, rash or feeling warm
• Swelling of the throat or tongue, throat tightness, hoarse voice or trouble swallowing

Who should not receive KRYSTEXXA?

Do not receive KRYSTEXXA if you have a rare blood problem called glucose 6-phosphate dehydrogenase (G6PD) deficiency or favism. Your doctor should test you for G6PD before you start KRYSTEXXA.

KRYSTEXXA is not recommended if you have high levels of uric acid without a history of gout.

Before you receive KRYSTEXXA, tell your doctor if you:

• Know you have G6PD deficiency
• Ever had any heart problems or high blood pressure
• Are pregnant or planning to become pregnant. It is not known if KRYSTEXXA will harm your unborn baby
• Are breastfeeding or plan to breastfeed. It is not known if KRYSTEXXA passes into your breast milk

Tell your doctor about all the medicines you take. Do not take any other uric acid lowering drug, such as allopurinol or febuxostat (Uloric^®), while taking KRYSTEXXA.

Prior to your treatment with KRYSTEXXA, your doctor may give you medicine to help reduce your chance of getting a reaction. Take these medicines as directed by your doctor or nurse. Your doctor will also test your uric acid levels prior to each treatment to monitor your response to KRYSTEXXA.

What are the possible side effects of KRYSTEXXA?

Please review important information section above. The most common side effects in patients taking KRYSTEXXA were gout flare-ups or attacks, allergic reactions, nausea, bruising, sore throat, constipation, chest pain and vomiting.

This is not a complete list of all possible side effects. Tell your doctor or treatment team if you have any side effect that bothers you or that does not go away.

Please see the Medication Guide and Prescribing Information for more information. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/safety/medwatch, or call the FDA at 1-800-FDA-1088.

KRYSTEXXA is a trademark owned by or licensed to Horizon.
©2021 Horizon Therapeutics plc P-KRY-01671-2 1/21

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References: 1. Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019 Jun;71(6):991-999. 2. Dalbeth N, et al. Nat Rev Dis Primers. 2019 Sep 26;5(1):69. 3. Grassi W, De Angelis R. Clinical Features of Gout. Reumatismo. 63(4), 238-245. 4. Chhana A, Dalbeth N. The Gouty Tophus: a Review. Curr Rheumatol Rep 17, 19 (2015). 5. KRYSTEXXA Prescribing Information. https://www.hzndocs.com/KRYSTEXXA-Prescribing-Information.pdf.