PEER PERSPECTIVE A nephrologist’s experience prescribing KRYSTEXXA

My name's Chris Gisler. I'm a board-certified nephrologist practicing in the Pittsburgh area. As a nephrologist, I feel that I'm responsible for the total care of my patients.

We’re already doing the best we can with chronic kidney disease, but our patients suffer from gout. There is actually a strong association between chronic kidney disease and gout... about a third of the patients that you’re taking care of have gout, most likely. It’s not just a disease of the big toe, not just a disease of the joints. We need to really consider this as a disease that’s affecting the whole body, multiple organ systems. We know that many different organs are affected, including the heart. We know that our patients with gout are at more risk for cardiovascular disease. To me, it does no good to prolong a patient’s life by managing their kidney disease if they’re absolutely miserable, right? If we treat gout, address gout, and do a better job with managing gout, we’re improving the patient’s overall functional status.

I met this patient that I had been following for chronic kidney disease. She was a bit on the obese side and so a lot of the joint pain that she complained to me about in her knees I attributed to osteoarthritis. She revealed to me that she had significant gout and actually had gone to the ER for a gout flare. We talked about it—she failed oral therapy with Allopurinol—and were able to prescribe her KRYSTEXXA. KRYSTEXXA is a biologic. As with many biologic therapies, there is a risk of anaphylaxis and infusion reactions. When we began managing her gout with KRYSTEXXA, she did have multiple flares at the beginning, which is a known effect of the gout treatment. Once she got through those first couple of treatments though, she really noticed improvement. The frequency and severity of flares were decreasing. Also, the pain she had just at baseline was markedly improved. She was able to ambulate more frequently and really was starting to get more and more of her life back. By treating with KRYSTEXXA we’re dramatically lowering the serum uric acid level, sort of draining the tub so that that serum uric acid level is zero, allowing that uric acid that was deposited into the joints to be pulled out. Many of the interventions we perform as nephrologists, patients don’t see a tangible benefit. With our patients on KRYSTEXXA, they start feeling better. I’m encouraging my patients to treat for at least 6 months. If they’re still seeing continued improvement, we’ll continue to treat. Now I do caution them that once you feel better that doesn’t necessarily mean that you are better. So, we know that in addition to flares for gout there’s also a subclinical gout. Damage is still being done to the joints even if they’re not actively flaring. And so, it’s very important to get gout under control.

I think for a nephrologist that would say, “Managing gout’s not my responsibility,” I would argue that it absolutely is. This is a disease process that we should be comfortable with. This is a disease process that kind of goes hand in hand with chronic kidney disease. Chronic kidney disease is a slow progressive disease where patients don’t necessarily see improvements. They say, “Doctor, I’m doing all the right things. I still don’t feel much better.” With gout, we can actually make interventions, so the patients come back and say they feel better. I think any time we can do something to make a patient feel better, to get them to become more active, to address an issue that they’re really concerned about, and to see marked improvement in it in a relatively short amount of time I think is really rewarding.

I'm Dr. Chris Gisler. These are our patients, and we need to take action.