Leflunomide is supported as cotherapy to pegloticase in patients with uncontrolled gout, according to a study published in Rheumatology and Therapy. With evidence suggesting that methotrexate administration can markedly improve pegloticase response rates but methotrexate use restricted by kidney disease—often presented in patients with uncontrolled gout—but leflunomide less restricted in patients with renal dysfunction, Karim Richard Masri, MD, and colleagues examined the treatment response rate of pegloticase (8 mg biweekly infusion) coadministered with oral leflunomide (20 mg/day) in patients with uncontrolled gout. Participants administered 12 or more pegloticase infusions who had and pre-infusion serum urate (SU) less than 6 mg/dl at infusion 12 were considered treatment responders. Responder criteria was met by 70% of patients, who received an average of 26.6 infusions (range, 13-55) and had a preinfusion 12 SU of 0.9 mg/dl. Non-responders received less than 12 infusions because of unrelated adverse events or loss of follow-up. “Heterogeneity and high comorbidity burden in uncontrolled gout patients makes having a variety of immunomodulators options important,” wrote Dr. Masri and colleagues.