medwireNews: A transdermal alkalinizing and pain-relieving treatment has been shown to effectively reduce the pain intensity and duration of an acute gout flare in the phase 2 TARGET study.
Current treatments for acute gout are considered to be equally effective, “but we know that they are non-selective, often toxic, and limited by drug-drug interactions,” commented Puja Khanna (University of Michigan, Ann Arbor, USA), who presented the findings at the EULAR 2022 Congress in Copenhagen, Denmark.
Khanna and co-researchers therefore looked at the potential for leveraging pH modulation, which she pointed out is “uniquely enabled by topical delivery.”
Khanna explained that by targeting the local microenvironment acidity, three key mechanisms of gout pathology can be affected: the inflammatory cascade can be reduced; nociceptive pathways can be changed by decreasing pain signal propagation; and gout crystals can be dissolved.
For the study, patients with gout (ACR/EULAR criteria score of at least 8 points) were randomly assigned to receive transdermal DYV702 10 g (n=48) or placebo lotion (n=50) three times a day for up to 7 days. The products were applied to the joint at the point of flare, alongside the initiation of colchicine (1.2 mg followed by 0.6 mg 1 hour later).
“DYV702 led to significantly better response rates and superior pain relief at 24 hours, which was sustained at 7 days,” Khanna reported.
There was a significant 30% improvement in the primary endpoint of sum of pain intensity from baseline to day 7 with DYV702 versus placebo, as well as a threefold improvement in median time to resolution (≥50% reduction in pain; 24 vs 72 hours), a twofold improvement in the response rate at 24 hours (57.7 vs 27.6%), and a 20% increase in overall response rate (95.8 vs 80.1%).
Other significant treatment benefits with DYV702 versus placebo included a reduction in rescue medication use (3.6 vs 24.1%), an improvement in physical function on the PROMIS-20 scale in the first 24 hours (16.7 vs 9.4%), and a smaller proportion of patients with moderate-to-severe joint tenderness as assessed by a clinician (28.0 vs 57.1%).
Khanna pointed out the significance of a reduction in rescue medication use, which she said “is critical for patients who have concomitant comorbidities and also have kidney disease and want to minimize use of systemic therapies.”
She concluded that DYV702 is “simple and intuitive to use,” in addition to being “well tolerated,” and therefore “a potential agent that can minimize systemic side effects of oral and other therapies” for gout.
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EULAR 2022; Copenhagen, Denmark: 1–4 June
Ann Rheum Dis 2022; 81: 112