Refractory or uncontrolled gout occurs when conventional treatment is unable to lower serum uric acid below the solubility limit and inflammation related to urate deposition continues to drive and progressively worsen signs and symptoms of gout.

The use of recombinant uricases can lead to antidrug antibody development, limiting both urate-lowering efficacy and therapy duration.

Immunomodulation co-therapy with a biologic agent like uricase is commonly used in rheumatology to mitigate immunogenicity and has been shown to increase treatment response rates in patients with uncontrolled gout treated with uricase-based therapies.

This review summarizes published reports on the use of recombinant uricases with immunomodulating co-therapy, finding improved treatment response and decreased antidrug antibody incidence.