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  • Prior to the first infusion, confirm your patient has normal G6PD activity from lab tests and has discontinued taking urate-lowering therapies (eg, allupurinol, febuxostat)
    •  Do not administer to patients with G6PD deficiency*

Learn more about G6PD screening

  • Remind your patient why they are not taking oral urate-lowering therapies and ensure they are taking gout flare prophylaxis
  • Confirm your patient is taking prescribed medications, including methotrexate and oral folic acid, if appropriate
    • If prescribing KRYSTEXXA with methotrexate therapy, this should be maintained throughout treatment with KRYSTEXXA
  • Prior to each subsequent infusion, confirm sUA level was tested in the last 48 hours
    • sUA is an adverse event biomarker that informs the safety and efficacy of KRYSTEXXA in clinical practice
    • Monitoring sUA 48 hours prior to infusions can help identify patients at risk for infusion reactions
    • Notify prescribing healthcare provider if sUA level has not been tested or if any preinfusion sUA level is >6 mg/dL, and discontinue therapy, particularly after 2 preinfusion sUA levels are >6 mg/dL

See the KRYSTEXXA Monitoring Protocol

  • Answer your patient’s questions about treatment, including diet changes or limitations, and offer a Medication Guide, which provides details about proper use, side effects, and combination use with methotrexate
  • Describe to your patient how KRYSTEXXA works, including the risk of infusion reactions
  • Remind your patient of the support services available to them through Horizon By Your Side, once they are enrolled (see Helpful Resources)
  • Advise your patient to learn more about what to expect along their journey
  • Identify your patient’s infusion location (office, hospital, infusion center, or at home)
    • KRYSTEXXA is indicated to be administered in a healthcare setting by professionals trained to manage serious allergic reactions.1 Potential use of home infusion must be determined by healthcare professionals’ assessment of individual patient needs.
  • Administer preinfusion medications per prescribing healthcare provider’s orders
    • IV corticosteroid
    • Antihistamine
    • Oral analgesic

See preinfusion medications

  • Remind your patient that they may experience gout flares, but KRYSTEXXA therapy can be continued regardless of gout flares
  • Visually inspect vial for particulate matter and ensure solution is clear and colorless
  • Using aseptic technique, withdraw 1 mL into a sterile syringe and inject into a 250-mL bag of normal or half-normal saline. Gently mix the bag by inverting several times and discard any unused portion of the remaining product. Do not shake.
    • No loading dose recommended or required
    • KRYSTEXXA is a single-dose vial
  • The diluted solution should be used within 4 hours
  • Before administration, allow the diluted solution of KRYSTEXXA to reach room temperature
    • Artificial heating should not be used
    • If not administered immediately, it is recommended that the diluted solution be stored in the refrigerator and away from light
  • Initiate infusion at a rate of 125 mL/h or slower via infusion pump or gravity feed
    • Infuse over no less than 2 hours

DO NOT ADMINISTER AS INTRAVENOUS PUSH OR BOLUS

  • The sticker on the KRYSTEXXA box is available for use on your patient’s chart, if desired
  • Use your normal protocol to monitor for infusion reactions
    • In the event of an infusion reaction, as clinically indicated, the infusion can be slowed or stopped and restarted at a slower rate
  • Observe your patient for approximately 1 hour postinfusion
  • Remind your patient of their next sUA test and KRYSTEXXA infusion appointments along with taking prescribed medications, including methotrexate and folic acid if appropriate
    • KRYSTEXXA should be given every 2 weeks—it is recommended to provide a standing order to the lab to check the patient’s sUA level prior to each infusion

*KRYSTEXXA is contraindicated for patients with G6PD deficiency. G6PD deficiency is an abnormally low level of glucose-6-phosphate dehydrogenase. Patients of African, Mediterranean, and South Asian ancestry have a higher risk of deficiency.1

sUA, serum uric acid.

Dosing: KRYSTEXXA co-administered with methotrexate1

KRYSTEXXA alone may be used in patients for whom methotrexate is contraindicated or not clinically appropriate.

†No dosing adjustments needed with KRYSTEXXA for patients with kidney disease.

‡If co-administration with methotrexate and folic acid, this should be maintained throughout treatment with KRYSTEXXA.

Adverse event biomarker: sUA informs the safety and efficacy of KRYSTEXXA

To better predict the occurrence of infusion reactions, a post hoc analysis of the pivotal clinical trials was completed. sUA was identified as a biomarker that informs the safety and efficacy of KRYSTEXXA in clinical practice. This led to the development of the KRYSTEXXA Monitoring Protocol.

Bar chart comparing incidence of infusion reactions based on sUA levels (Per 100 infusions), with .4 reactions in the placebo group, .5 in the sUA less than or equal to 6 mg/dL group, and 4.8 in the sUA above 6 mg/dL groupBar chart comparing incidence of infusion reactions based on sUA levels (Per 100 infusions), with .4 reactions in the placebo group, .5 in the sUA less than or equal to 6 mg/dL group, and 4.8 in the sUA above 6 mg/dL group

Adapted with permission from Baraf HSB, et al. J Clin Rheumatol. 2014;20(8):427-432.

§Based on infusion reactions per patient.2

sUA, serum uric acid.

Monitoring protocol

Monitoring sUA 48 hours prior to infusions can help identify patients at risk for infusion reactions1,2

Graphic of the KRYSTEXXA monitoring protocol, directing to take a preinfusion sUA measurement, preferably 48 hours prior to each infusion, and continuing treatment if the preinfusion sUA level is less than or equal to 6 mg/dLGraphic of the KRYSTEXXA monitoring protocol, directing to take a preinfusion sUA measurement, preferably 48 hours prior to each infusion, and continuing treatment if the preinfusion sUA level is less than or equal to 6 mg/dL

sUA, serum uric acid.

IMPORTANT SAFETY INFORMATION

WARNING: ANAPHYLAXIS AND INFUSION REACTIONS, G6PD DEFICIENCY ASSOCIATED HEMOLYSIS AND METHEMOGLOBINEMIA

  • Anaphylaxis and infusion reactions have been reported to occur during and after administration of KRYSTEXXA.
  • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within 2 hours of the infusion. Delayed hypersensitivity reactions have also been reported.
  • KRYSTEXXA should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions.
  • Premedicate with antihistamines and corticosteroids and closely monitor for anaphylaxis for an appropriate period after administration of KRYSTEXXA.
  • Monitor serum uric acid levels prior to each infusion and discontinue treatment if levels increase to above 6 mg/dL, particularly when 2 consecutive levels above 6 mg/dL are observed.
  • Screen patients at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to starting KRYSTEXXA. Hemolysis and methemoglobinemia have been reported with KRYSTEXXA in patients with G6PD deficiency. KRYSTEXXA is contraindicated in patients with G6PD deficiency.

CONTRAINDICATIONS:

  • In patients with G6PD deficiency.
  • In patients with history of serious hypersensitivity reactions, including anaphylaxis, to KRYSTEXXA or any of its components.

WARNINGS AND PRECAUTIONS

Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.

Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.

ADVERSE REACTIONS

The most commonly reported adverse reactions (≥5%) are:

KRYSTEXXA co-administration with methotrexate trial:

KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.

KRYSTEXXA pre-marketing placebo-controlled trials:

gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.

INDICATION

KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.

Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.

Please see Full Prescribing Information, including Boxed Warning.

IMPORTANT SAFETY INFORMATION

WARNING: ANAPHYLAXIS AND INFUSION REACTIONS, G6PD DEFICIENCY ASSOCIATED HEMOLYSIS AND METHEMOGLOBINEMIA

  • Anaphylaxis and infusion reactions have been reported to occur during and after administration of KRYSTEXXA.
  • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within 2 hours of the infusion. Delayed hypersensitivity reactions have also been reported.
  • KRYSTEXXA should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions.
  • Premedicate with antihistamines and corticosteroids and closely monitor for anaphylaxis for an appropriate period after administration of KRYSTEXXA.
  • Monitor serum uric acid levels prior to each infusion and discontinue treatment if levels increase to above 6 mg/dL, particularly when 2 consecutive levels above 6 mg/dL are observed.
  • Screen patients at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to starting KRYSTEXXA. Hemolysis and methemoglobinemia have been reported with KRYSTEXXA in patients with G6PD deficiency. KRYSTEXXA is contraindicated in patients with G6PD deficiency.

CONTRAINDICATIONS:

  • In patients with G6PD deficiency.
  • In patients with history of serious hypersensitivity reactions, including anaphylaxis, to KRYSTEXXA or any of its components.

WARNINGS AND PRECAUTIONS

Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.

Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.

ADVERSE REACTIONS

The most commonly reported adverse reactions (≥5%) are:

KRYSTEXXA co-administration with methotrexate trial:

KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.

KRYSTEXXA pre-marketing placebo-controlled trials:

gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.

INDICATION

KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.

Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.

Please see Full Prescribing Information, including Boxed Warning.

  • KRYSTEXXA (pegloticase) [prescribing information] Horizon.
  • Baraf HSB, et al. J Clin Rheumatol. 2014;20:427-432.