How would you manage a patient on pegloticase and immunomodulation in whom the uric acid has never dropped below 6?

Pegloticase, a PEGylated uricase enzyme infused every two weeks for gout is highly effective but highly immunogenic. Patients responsive to pegloticase typically lower their serum uric acids (SUA) to <0.1mg/dL or thereabout. The initial phase 3 studies had a primary endpoint of sustained uric acid l...