Which intravenous infusion drug is indicated for chronic gout that is refractory or tophaceous and can cause anaphylaxis as a potential adverse effect?

• A. Pegloticase
• B. Allopurinol
• C. Colchicine
• D. Febuxostat

Answer: (A)

For chronic gout that is refractory to standard therapy or involves tophi, the intravenous infusion option is pegloticase. This drug is a pegylated recombinant uricase that breaks down uric acid into allantoin, which is more soluble and easier to excrete. It’s reserved for patients who have not achieved target urate lowering with conventional therapies or who have significant tophaceous disease. Because pegloticase is a foreign enzyme, infusion reactions are possible and can be severe, including anaphylaxis, so it’s given under close supervision during infusions and patients are monitored for hypersensitivity. It’s also important to note it’s not a first-line oral agent like allopurinol or febuxostat, and it’s not used for acute flares like colchicine. These features—the intravenous administration for refractory chronic gout and the risk of anaphylaxis—make pegloticase the correct choice.