After failure with xanthine oxidase inhibitors, which type of drug is used to inhibit the URAT1 transporter to lower uric acid?

After failure with xanthine oxidase inhibitors, which type of drug is used to inhibit the URAT1 transporter to lower uric acid?

• A. Lesinurad (Zurampic)
• B. Probenecid
• C. Pegloticase
• D. Febuxostat

Answer: (A)

The main idea is to increase uric acid excretion by blocking its reabsorption in the kidney. URAT1 is the transporter in the proximal tubule that reabsorbs uric acid from the urine back into the blood. Inhibiting URAT1 means more uric acid stays in the urine and is excreted, lowering serum urate levels. Lesinurad is a selective URAT1 inhibitor (a uricosuric) used after failing to reach target uric acid levels with xanthine oxidase inhibitors, often in combination with an XO inhibitor to maximize urate lowering. Probenecid is another URAT1 inhibitor but is older and less commonly used nowadays. Pegloticase works by enzymatically breaking down uric acid (uricase) and is for refractory gout, not a URAT1 blocker. Febuxostat is a xanthine oxidase inhibitor, reducing uric acid production rather than altering its renal handling.

The main idea is to increase uric acid excretion by blocking its reabsorption in the kidney. URAT1 is the transporter in the proximal tubule that reabsorbs uric acid from the urine back into the blood. Inhibiting URAT1 means more uric acid stays in the urine and is excreted, lowering serum urate levels. Lesinurad is a selective URAT1 inhibitor (a uricosuric) used after failing to reach target uric acid levels with xanthine oxidase inhibitors, often in combination with an XO inhibitor to maximize urate lowering. Probenecid is another URAT1 inhibitor but is older and less commonly used nowadays. Pegloticase works by enzymatically breaking down uric acid (uricase) and is for refractory gout, not a URAT1 blocker. Febuxostat is a xanthine oxidase inhibitor, reducing uric acid production rather than altering its renal handling.