Do you delay pegloticase in a patient with an active gout flare?

I don’t. The patient should be on prophylactic colchicine (if their renal function allows), and part of their pre-treatment involves the systemic administration of corticosteroids anyway such as hydrocortisone (used in the initial drug trials) or methylprednisolone (Solu-Medrol). It is known that during the first few months of pegloticase use the number of gout flares may actually increase, as seen in the drug trials, the reason prophylactic colchicine is recommended,

I agree with Dr. @Dr. First Last. Once the decision is made to treat refractory gout with pegloticase there will be (or should be) a "built-in delay" of 3-5 weeks during which methotrexate or another immunomodulator is typically administered to suppress anti-pegloticase antibody formation and to ensure a successful course of treatment.

The hallmarks of refractory gout: recurrent flares, chronic (or acute on chronic) synovitis and/or the functional impairment caused by tophaceous deposits constit...