Refractory, or uncontrolled, gout is a chronic, progressive, inflammatory arthropathy resulting from continued urate deposition after failed attempts to lower serum uric acid below the therapeutic threshold with oral urate-lowering therapies such as allopurinol and febuxostat. Recombinant uricase is increasingly being used to treat refractory gout; however, the immunogenicity of uricase-based therapies has limited the use of these biologic therapies. Antidrug antibodies against biologic therapies, including uricase and PEGylated uricase, can lead to loss of urate-lowering response, increased risk of infusion reactions, and subsequent treatment failure. However, co-therapy with an immunomodulator can attenuate antidrug antibody development, potentially increasing the likelihood of sustained urate lowering, therapy course completion, and successful treatment outcomes. This review summarizes evidence surrounding the use of immunomodulation as co-therapy with recombinant uricases.

难治性或不受控制的痛风是一种慢性、进行性、炎症性关节病，其原因是在尝试使用别嘌醇和非布司他等口服降尿酸疗法将血清尿酸降低至治疗阈值以下失败后，尿酸持续沉积。重组尿酸酶越来越多地用于治疗难治性痛风；然而，基于尿酸酶的疗法的免疫原性限制了这些生物疗法的使用。针对生物疗法（包括尿酸酶和聚乙二醇化尿酸酶）的抗药抗体可导致降低尿酸反应的丧失、输液反应风险增加以及随后的治疗失败。然而，与免疫调节剂的联合治疗可以减弱抗药抗体的产生，可能会增加持续降低尿酸盐、完成治疗过程的可能性，和成功的治疗结果。本综述总结了有关使用免疫调节作为重组尿酸酶联合治疗的证据。