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Gout Dugout.Issue #067.lesinurad completes successful trials | curing gout naturally
September 29, 2014

Hello and Welcome to the Autumn/Fall (late September) 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.


Astra Zeneca PLC (AZ) finally announced the results of its last 3 phase three trials of its new gout drug Lesinurad, but the company has not yet provided details of its adverse reactions/side effects. Lesinurad was tested with allopurinol and febuxostat i.e. as a combination therapy at different strengths (200 mg and 400 mg). Its effect on lowering uric acid with allopurinol and febuxostat was good.

This is what Astra Zeneca said:

"In the CLEAR1 and CLEAR2 trials, both lesinurad 200mg and 400mg in combination with allopurinol met the primary endpoint, with a statistically significant higher proportion of patients reaching the target sUA (serum uric acid) goal of < (less than) 6.0mg/dL at month 6 compared to allopurinol alone.

In the CRYSTAL trial, lesinurad 400mg in combination with febuxostat met the primary endpoint, with a statistically significant higher proportion of patients reaching the target sUA (serum uric acid) goal of < (less than) 5.0mg/dL at month 6 compared to febuxostat alone. Although lesinurad 200 mg did not achieve statistical significance at month 6, this dose in combination with febuxostat, was superior to placebo plus febuxostat at all other time points (measured at months 1 to 5, 8, 10 and 12; nominal."

Lesinurad improves uric acid excretion by blocking a kidney transporter (URAT1) from returning it to the blood..... and allopurinol and febuxostat stymie its production. So in combination therapy there is a two front "attack" on uric acid to reduce its serum (blood) levels by more than a single med, and more quickly.

Phase 3 drug trials are the last before a developer applies to government health authorities for marketing approval. AZ said they would do this (probably for the U.S. and EU nations) by the end of this year. The company propose using it at 200 mg strength, and with allopurinol and febuxostat. It has been trialed at 400 mg with febuxostat but AZ won't use it at this strength.

Astra Zeneca's wish to proceed means the company must be confident lesinurad’s adverse reactions will be considered acceptable. They paid a hefty price for it when they bought its original developers Ardea Biosciences a few years ago.

AZ are still trialing lesinurad to learn and confirm more about its adverse reactions. They report upper respiratory tract infections, nasopharyngitis, (inflammation of the nasal passages and of the upper part of the pharynx), arthralgia (joint pain) and back pain were the most common across all three trials. The results of these tests will be announced later this year.


Every so often I get a real humdinger of a submission on a website form. A "humdinger" is a submission where something about gout is said, by a expert or sufferer, that supports with some details circulating gout ideas that are considered helpful and possibly true, but have not been studied scientifically. Most of course are in the realm of natural gout remedies, which science has so far generally ignored. Or perhaps, as is the case of lithium and gout, more or less forgotten.

This humdinger came from a website visitor in Nevada, USA. He is a dedicated seeker after natural gout remedies, and he had been a long term gout sufferer, before it was at last diagnosed correctly, (late diagnosis is quite common). His gout had reached the tophi level, with attacks in most of the usual places.

I don't have to repeat what he said here, since this link goes to the page about his experience and suggestions

His star treatment performer has been the herb devil's claw, which is reputed to lower uric acid.

His other key remedy target has been to boost the performance of his liver with herbs, dietary supplements, and certain vegetables and nuts. Read about them on that page too – use the link above.

On this page there is also a link to the radio phone-in show of Dr. Peter Glidden ND, which has a segment about gout. It features a phone-in guest whose gout has reached the tophi stage. Dr. Glidden gives him a remedy protocol (list of natural meds to use).

Use the simple instructions there to go directly to the gout segment if you haven’t time to listen to the whole program (programme) which covers other medical topics. Worth a listen I'd say.


Kidney donors are heroes in societies everywhere, much blessed by those who receive one. But they may pay as price later on. The kidneys are the organ that both remove uric acid and return it to the blood and so play a huge role in gout.

Researchers from the London Health Services Centre in London, Ontario, (not the other London), reported to the 2014 World Transplant Congress in San Francisco in July on an 8 year study about the risk of gout from kidney donation.

They monitored 1,988 living kidney donors and 19,880 healthy non -donors over around 8 years. It turned out the donors were more likely to develop gout than the non-donors (3.4% donors v 2% non -donors). The difference of 1.4% translated into a 60% increased risk of gout for the donors. And uric acid levels rose in donors by 8.2% after 6 months which isn't so much. But 20% after 7 years, which is much more likely to cause gout.


Kim Jong Un, the 31 years old supreme leader of the maverick state of North Korea has gout, although his state media gave it a euphemistic description - an "uncomfortable physical condition." This is the fellow who has fired missiles in the direction of Japan, carried on developing nuclear weapons, and he has threatened the United States with them.

But communist dictators are not immune to the sins of "capitalist consumerism." A former boss of the KGB, Yuri Andropov, who even became Soviet leader in the 1980's, was a gout sufferer too.

I think North Korea is the only sizeable country in the world from where does not get any visitors. The website has for example, in 2014 received visitors from countries like Iraq, Iran, Afghanistan, Burma (Myanmar), Syria and Palestine, where you might imagine censorship or other difficulties. And even from tiny places like Bhutan, Andorra, St. Helena, and the Turks and Caicos Islands. But not North Korea.

He has recently missed a big meeting and been seen limping at an outside event, probably the aftermath of an attack. How can a relatively young man like this get gout? Easy. His grandfather Kim Il Sung (the founder of the North Korean state) and his father Kim Jung Il both suffered gout, so does his elder brother. Some media also mentioned his fondness for Emmenthal cheese (the Swiss cheese with the holes) but this cheese is low purine and very unlikely to raise uric acid.

And he has, it was said, tried to put ON weight, so to look more like his grandfather. Given his genes, not a wise thing to do. He also suffers all the hallmarks of metabolic syndrome, which may be the immediate cause in his case.

It seems to be a classic case of inherited gout and he probably has 40-50 upcoming years of dealing with it.

No doubt the CIA will write a paper on the implications of all this, but I could save them some of the trouble. Unless he learns how to deal with it, and he may have picked up tips from the father and grandfather, gout will in its usual inexorable way, get worse, more painful, and tophi will develop. The world faces the prospect in 20-30 years of a nuclear armed state run by a gout sufferer with his "finger on the button," whose moods have been darkened by the pains and troubles it brings.

We shall have to hope that Kim Jong Un learns how to deal with gout. In the meantime I'll check occasionally to see if the website does get just a single visitor from North Korea, based in its capital Pyongyang.

If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

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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 Rasburicase? Type that in the site search box. There are currently around 225 pages, including all the back issues of this newsletter. It works. Use it!

Next issue – towards the end of December.

Thanks for reading and all the best of health.

John Mepham BA (Econ).
Makati City,

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