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Gout Cavalcade (7.10.2026)
Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week. July is Gout: More than Flares month.
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FDA Delays Gout Drug NASP with Complete Response Letter
At the end of June, Sobi was awaiting an FDA decision on its Biologics License Application (BLA) for NASP (nanoencapsulated sirolimus plus pegadricase) for the treatment of adult patients with uncontrolled gout. On June 26, 2026, SOBI received a Complete Response Letter from the U.S. FDA that will delay a decision on NASP, pending the company's answer to questions regarding the drugs manufacturing at a 3rd party facility in China.
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Problems with treatment adherence in the management of gout
Compared to common medical conditions such as hypertension, type 2 diabetes, hyperlipidemia or osteoporosis, where the reported drug adherence rates are between 50% to 70%, the drug adherence for gout is 37%.
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Uric Acid: Is Lower Better?
Lowering serum urate and urate crystals in the body is indispensable for long-term management of gout. The pathophysiology is simple and powerful: no urate crystals, no gout flares.
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🎥 In this RheumNow Therapeutic Update, Dr. Nicola Dalbeth reviews the latest evidence on the Outcomes of Tophaceous Gout and what every rheumatologist should know.
Watch now: https://t.co/KQmkdziLF5
#Gout #Rheumatology #MedEd #SystemicBurdenOfGout https://t.co/h8LhE5XW00
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Netherlands pragmatic open-label RCT from 8 rheum centres tested T2T vs Sx Rx in 308 Gout pts starting ULT (87% male; 66 yrs). Remission (no flares & pain < 2) betw 18-24 mos was more in T2T pts (39% vs 24%; p=0.02), but more AE w/ Sx driven Rx (53 vs 42%) https://t.co/5g2dY5y900
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Challenges in Gout Diagnosis
Dr. Angelo Gaffo in Birmingham, AL discusses the challenges in diagnosing gout. Presented as part of RheumNow's "Gout: More than Flares" campaign during the month of July 2026.
https://t.co/LmTj7cvBGT https://t.co/VRVCrAo2TT
Dr. John Cush RheumNow ( View Tweet)
QD CLINIC: Senior Year Gout
Daric Mueller, PA-C, discusses a case of difficult-to-treat gout in an individual first diagnosed at age 18 who is now in his early 30s. This QD Clinic is presented as part of RheumNow's "Gout: More than Flares" campaign.
https://t.co/9GNk8ZqwyS https://t.co/hAFz6zPcay
Dr. John Cush RheumNow ( View Tweet)
Weight loss helps gout, but extreme weight loss (bariatric surgery, ketogenic diets) may trigger gouty attacks. (Not seen with GLP-1 agonist weight loss)
For more gout content, follow our Gout: More than Flares campaign at https://t.co/xnBVBN5IXZ, https://t.co/LGEENexSZ6
Dr. John Cush RheumNow ( View Tweet)
Uric Acid: Is Lower Better?
There is good evidence that a serum urate less than 6 mg/dL is required to meaningfully reduce urate crystal and gout flare burden, but is even lower better and are there any tradeoffs?
https://t.co/yVZOuMhZmr https://t.co/Ldc1pBQThH
Dr. John Cush RheumNow ( View Tweet)
< 40% of gout patients are on ULT; <40% of ULT-treated gout patients achieve T2T (SUA < 6.0 mg/dl).
For more gout content, follow our Gout: More than Flares campaign at https://t.co/j3iLMZz4HM, https://t.co/zFTozS62me
Dr. John Cush RheumNow ( View Tweet)
How should imaging guide the diagnosis and management of gout?
Hear from Dr. Nicola Dalbeth, Dr. John Fitzgerald, and Dr. Sarah Tedeschi, moderated by Dr. Jack Cush, as they discuss ultrasound, DECT, crystal identification, and more.
📅 Reserve your seat today.
Link: https://t.co/GySPzyVc1b
Dr. John Cush RheumNow ( View Tweet)
Gout is more than an episodic arthritis, it's a systemic inflammatory disease.
Watch Dr. Robert Terkeltaub discuss 3 New Things it Pays to Know About Gout Pathobiology, including emerging insights that are shaping how we understand and manage gout.
Watch now on RheumNow: https://t.co/nri3WDz7kS
Dr. John Cush RheumNow ( View Tweet)
The global Chronic Refractory Gout Market is projected to grow from ~$2.94 billion USD in 2022 to nearly $10.07 billion USD by 2036, reflecting introduction of innovative therapies. Chronic Refractory Gout in the 7Major Markets exceeded 400,000 pts in 2025 (>200K in USA) https://t.co/MSzBNTXTPj
Dr. John Cush RheumNow ( View Tweet)
Long term F/U of Gout (CARES) trial (febuxostat vs allopurinol) shows remission increased from 37% (1,593/4,259) 1st Yr to 63% (322/510) at year 6. Over the 6 years, ~60 achieved remission at least once; more likely based on age, race, dz severity, comorbidities, & febuxostat
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Chinese target trial emulation of 2092 adults with stage G3–G4 CKD & asymptomatic hyperuricemia starting ULT. At 3 yrs, renal progression (ESKD or ≥40% eGFR decline) was 33.3% in T2T vs 35.8% in non-T2T (risk ratio 0.93; 0.83–1.08). https://t.co/lAT0noE1uA https://t.co/mFVpvvFcsN
Dr. John Cush RheumNow ( View Tweet)
Cochicine overdose still occurs & can be deadly. There is no antidote. From 2011-2021, there were 57 pediatric cases (median 7 yrs)(0.41 /million kids/year. 52% started w/ GI Sxs, 12% multiple organ failure &4 deaths (7%). Ingested doses ranged from 0.01 to 1.45 mg/kg. https://t.co/RULmdBX0Qj
Dr. John Cush RheumNow ( View Tweet)
RHEUM SURVEY>> Which Gout drugs lower the risk of cardiovascular death? Answer here: https://t.co/1OY1B3ET7B https://t.co/MRJP5OOtXb
Links:
Dr. John Cush RheumNow ( View Tweet)
ICYMI: Worldwide Trends in Hyperuricemia
A Lancet Rheumatology systematic review shows the prevalence of hyperuricaemia has risen markedly over the past two decades in both men and women, owing to population growth, aging, and increasing age-specific rates. https://t.co/8QAWkka0DM
Dr. John Cush RheumNow ( View Tweet)
RT @aurelierheumo
A long release version of xanthine oxidase inhibitor in gout
-442 pts 36 wks
-HR091506 vs febuxostat
-SUA <300 μmol/L: 63.8% vs 40.7% (Δ +22.9%, p<0.0001)
-higher SUA reduction vs baseline
-Similar overall TEAEs (~90%)
A molecule to keep an eye on!
#LB0008
Dr. John Cush RheumNow ( View Tweet)
