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Gout Dugout.Issue #066. erectile dysfunction and gout | new gout drugs make progress
June 29, 2014

Hello and Welcome to the Summer (late June) 2014, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read that gives you ideas that may help with your gout. Copy and print if you prefer to read a version on paper. If you are extra busy now, you could bookmark it for later.

If this issue goes to your spam box it is, I am afraid, because of one of the topics this month. In my experience spam checkers are usually fairly good, but not always so sophisticated.

ERECTILE DYSFUNCTION (ED) FOUND TO BE COMMON IN GOUT PATIENTS

The message is – suffering from gout? Check for ED, although it could be caused by something else. But scientifically more needs to be known.

Erectile dysfunction and gout is bound to be a sensitive topic but whilst it has been relatively overlooked in the past I have a feeling that it will be a growth subject.

Sex does NOT give you gout, but how much does gout allow men to have sex?

These issues, came into focus in June at the European League against Rheumatism (EULAR) annual conference in Paris.

Dr Naomi Schlesinger spoke to delegates about ED and gout. She is a leading gout researcher and was half of the research team who in a study a few years ago, found that cherry juice concentrate did have beneficial effects against inflammation and uric acid.

Her name appears on many scientific gout studies. She is Chief of the Division of Rheumatology and Professor of Medicine, at the Rutgers-Robert Wood Johnson Medical School, New Jersey, USA.

In her EULAR talk, Dr. Schlesinger explained that she first considered the link between ED and gout when she realised (realized) how much of the well known drug aide she prescribed for her gout patients. Note that at this practice at least gout patients ask for the famous drug that begins with a V.

So with colleagues, she undertook a survey of 201 patients at a rheumatology clinic. Not surprisingly it was found that a significant number of them (83) had gout. And she found that of those with gout three quarters had ED. Of those with ED and gout 43% described their ED as severe.

When confounding factors like age (of course), obesity and hypertension, which are among ED causes were considered, the association between the two was still significant.

This isn’t the first survey to reach this conclusion. In 2010 the journal Arthritis & Rheumatism reported on a U.S. study that also concluded ED is associated with gout. Among 256 gout sufferers 40% had ED compared to non-gout sufferers (29%). After adjusting for age (a common ED cause), there was still a significant association between the two. (1)

But not after adjusting for hypertension, obesity and diabetes, which are also risk factors for ED. And a large British database investigation a few years ago concluded there was no association between ED and gout. (2) So more needs to be learnt.

Because earlier awareness of ED on gout patients would lead to quicker treatment for it, Naomi Schlesinger called at EULAR for ED screening for gout patients. However, somehow I think it will be a long time before that happens on a routine basis.

But you think you have gout? It might be advisable to tell your GP (PCP) whether you think you have ED too. But the ED might have another cause of course.

Dr.Schlesinger may have kicked off a bigger debate about erectile dysfunction and gout.

Gout news video Want to know more ? Here is a ten minutes' YouTube video of Dr.Schlesinger talking about ED and gout at EULAR

BED GADGETS, FOR A GOUT SUFFERER’S BETTER NIGHT’S SLEEP

For a few years we had a link on best-gout-remedies.com to a bed gadget called the Foot Tent which lifts up sheets and blankets, making space around sensitive or sore lower legs, ankles, feet including of course toes. Now an American entrepreneur has come up with similar idea for keeping bed sheets, blankets, quilts, duvets off those inflamed and sore toes and feet at night. He calls his device The Blanket booster. A friend of his, who is a gout sufferer, partly inspired its development.

It also elevates sheets and other bed impedimenta, so that feet and toes do not have to deal with the problem of the weight of a sheet etc., which gout patients famously can’t bear when an attack is underway.

There’s a photos of the Blanket booster on its website.

There's also one called The Toe Tent

NEW GOUT DRUGS – INTERESTING DEVELOPMENTS

The research search for better gout drugs has triggered a fair amount of news in the past 3 months since the last edition of the Gout Dugout. There has been news about four of them:

Namely Uricase PEG-20, Xoma 052, REV-OO2, and Arhalofenate.

I’ll start with the biggest news.

Uricase PEG-20, also now with the generic name of Pegsiticase, is a somewhat similar biologic drug to Pegloticase (Krystexxa), and Raburicase – a specialised (specialized) anti uric acid drug for tumor lysis syndrome. Like these, Uricase PEG-20 is also intended for very troubling gout cases because it’s good at reducing uric acid. It converts uric acid to allantoin which is better excreted.

Uricase PEG-20 has been around in the background for a long time – there was a study way back in 1988 - without any company really trying to develop it, and get it approved, including during the years whilst pegloticase was developed into the branded drug Krystexxa.

It has been through Phase 1 clinical tests in the U.S. A few years ago a Chinese based company, 3SBio, bought it but we heard nothing more. Until now that is. Selecta Biosciences Inc. of Massachusetts, U.S.A. has joined forces with 3SBio to develop it.

There is a very big idea here. They will marry Selecta’s SVP (synthetic vaccine particle platform, as they call it), to 3SBio’s pegsiticase. The compound is called SEL-212. As I understand it, the SVP modifies the immune system’s response, so that it greatly reduces or eliminates side effects and adverse reactions. Which is just what gout biologics need, since most patients treated with these develop unwanted reactions.

With this "marriage" the two companies hope they can dramatically improve treatment for serious gout cases. We hope so. Proof of concept clinical studies for pegsiticase are due to start in 2015.

AR-HA! It's Arhalofenate The second biggest news I’d say, concerns Arhalofenate, which promises another breakthrough in gout treatment.

It is the case that there is an increased risk of gout attacks when uric acid levels are falling. That’s why colchicine is often also prescribed, along with the med to lower uric acid. Gout flares, when uric acid is actually falling, upset some sufferers who think gout is improving, then change their mind. It is, but the flares confuse them.

Step forward Arhalofenate, another gout drug with a cumbersome generic name. This med, which is in Phase 2 trials, has both reduced gout attack frequency, length and severity AND lowered serum (blood) uric acid by encouraging its excretion.

It was previously developed for Type 2 diabetes so it has been found to reduce glucose, and lower triglycerides and inflammation markers. And most interestingly for gout sufferers it has improved insulin sensitivity. If insulin resistance is to-day’s leading cause of gout, that could be very useful. Its developers, CymaBay Therapeutics, have announced another Phase 2 study among about 225 gout patients.

Other new gout drug news…… Rev-002 is being developed by a Canadian company, Revive Therapeutics Ltd. Revive are seeking to commence a clinical trial in the U.S. for an Asian arthritis treatment, which has a gout application.

The new gout drug Xoma-052 has been re-named gevokizumab. What a mouthful, will it need a free pronunciation DVD? No….. it will have an easier brand name if it gets to market. Its developer, Xoma Corp, have said a proof of concept programme (program) is underway for this new anti-inflammatory drug that can work to counter inflammation caused by gout’s crystals.

Don’t hold your breath that these meds will be available tomorrow. Developing new drugs is a tedious, painstaking task, where the drug companies spend an awful lot of money. Whilst these are off the ground, they will still take years to get approved.

But one new gout drug that could be close to an approval application is Lesinurad.....

The results of three Phase 3 trials of Lesinurad have been due this month from the British based pharma giant AstraZeneca PLC. But AstraZeneca, who bought Lesinurad a couple of years ago, was itself recently the subject of a takeover bid from Pfizer Inc. This eventually failed. But this bid may have slowed down the trials’ results’ announcement. Because as of today, June 29th, there's no news. So I'll report in September.

Lesinurad encourages uric acid excretion and, like other uric acid excretion drugs such as probenecid and benzbromarone, it’s good at lowering uric acid. It is due to file for approval in the U.S. and E.U. in the last three months of this year.

NEW ZEALAND MAKES FEBUXOSTAT AVAILABLE

New Zealand (NZ) has a lively gout scene, if lively is the right word for gout. Its Maori population are said to have the highest incidence of gout in the world. And for a small country it currently generates a lot of gout research, for example the last research about Vitamin C for gout, and new research into the genetic cause of gout.

Pharmac, the NZ government Crown agency for pharmaceutical management, announced it would fund febuxostat, beginning June 1st 2014.

AMERICAN FOOTBALL STAR GETS GOUT

Retired American football and dancing pro Emmitt Smith excelled at two activities, football and dancing, (Dallas Cowboys, Arizona Cardinals and Dancing with the Stars), but that didn’t stop him getting gout.

Or maybe the excessive exercise contributes to the cause, something I always suspect from those who exercise a great deal. And gout runs in his family – twice, both his grandfathers knew what it’s really like. So there’s a genetic cause too. Up to now Emmitt Smith has done well using febuxostat to lower uric acid.

His best tip? Know your uric acid levels and monitor them regularly. Amen to that.


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WEBSITE TIP

Use the website's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Raburicase? Type that in the site search box. There are currently around 215 pages, including all the back issues of this newsletter. It works. Use it!

Next issue – towards the end of September.

All the best of health.

John Mepham BA (Econ).
Makati City,
Philippines.

(1) W. Maynard, Janet, A. McAdams, Mara, N. Baer, Alan, Hoffman-Bolton, Judith, C. Gelber, Allan, Coresh, Josef; Erectile Dysfunction Is Associated with Gout in the Campaign Against Cancer and Heart Disease (CLUE II). Abstract. Arthritis Rheum 2010;62 Suppl 10 :1544 DOI: 10.1002/art.29310

(2) E Roddy, S Muller, R Hayward, CD Mallen Gout, allopurinol and erectile dysfunction: an epidemiological study in a primary care consultation database. Presentation. Arthritis Research UK, Primary Care Centre.

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