Treatment
Gout research and what’s ahead
A plain-language look at recent gout research and at newer medicines, some approved and some still in trials. It’s meant to help you ask good questions, not to choose a treatment.
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Recent findings
- Treat-to-target
The 2020 ACR guideline strongly recommends a treat-to-target strategy for people taking urate-lowering medicine. The dose is adjusted using repeat blood urate tests until a target is reached, rather than staying on a fixed dose.
- Flares and the heart
A large 2022 study of UK health records (JAMA) found heart attacks and strokes were more common in the weeks to months after a gout flare. The design shows an association, not proof that flares cause them.
- CANTOS and IL-1
CANTOS (2017) tested canakinumab, which blocks a signal called interleukin-1β, for heart disease. A later exploratory analysis found fewer gout attacks in people on canakinumab, though their blood urate did not change.
- Colchicine heart studies
The FDA approved a low-dose colchicine product (Lodoco) in 2023 to lower heart-event risk in some adults with heart disease, mainly based on the LoDoCo2 trial. In 2024, the CLEAR SYNERGY trial found no benefit from colchicine started soon after a heart attack. This is heart research, not a gout approval.
- Genetics
Genes that move urate in the kidney and gut, especially SLC2A9 and ABCG2, have strong effects on urate levels and gout risk. One ABCG2 variant is linked to a weaker response to allopurinol.
- Safer prescribing
Testing for the gene variant HLA-B*5801 before starting allopurinol is recommended in some higher-risk populations. A genetics review says this testing has reduced a rare but serious reaction.
Newer medicines
Status as of . These details change, so check with your clinician or ClinicalTrials.gov.
- Canakinumab (Ilaris)FDA approved for flares, 2023
Approved in 2023 for gout flares in adults who can’t use NSAIDs or colchicine, or don’t get enough relief from them, and for whom repeated steroid courses aren’t appropriate. It is an IL-1 blocker.
- Anakinra (Kineret)Not FDA approved for gout
Anakinra is also an IL-1 blocker. Its FDA label covers rheumatoid arthritis and some rare inflammatory conditions, but not gout. The 2020 ACR guideline conditionally recommends IL-1 blockers for flares when the usual medicines don’t work or can’t be used.
- NASP (formerly SEL-212)FDA asked for more data, June 2026
Pegadricase, an enzyme that breaks down urate, given with a sirolimus nanoparticle product (once called ImmTOR). On June 26, 2026, the FDA asked for more manufacturing data instead of approving it. The company says no clinical safety or efficacy concerns were raised and it plans to resubmit.
- Pozdeutinurad (AR882)In phase 3 trials
A daily pill that helps the kidneys clear urate (a URAT1 blocker). Sobi reported in May 2026 that the REDUCE 2 trial met its main goal. Results from REDUCE 1 were expected in the second half of 2026. It is not approved.
- DotinuradApproved in Japan; US trials recruiting
A URAT1 blocker approved in Japan in January 2020. As of October 2026, ClinicalTrials.gov lists phase 3 studies comparing it with allopurinol in gout as recruiting. It is not FDA approved.
- EpaminuradPhase 3 done; not yet approved
Another URAT1 blocker. In August 2026, JW Pharmaceutical reported that its phase 3 trial in five Asian countries met its main goal against febuxostat at its main dose. It plans to apply in South Korea and is aiming for approval in 2027.
- TigulixostatDevelopment stopped by LG Chem
A xanthine oxidase inhibitor, the same type of medicine as allopurinol. LG Chem stopped developing it in March 2025 for business reasons, not safety. Its phase 3 allopurinol-comparison trial is listed as completed. A partner held rights in China.
Early research isn’t proven care
Questions to ask your doctor about newer treatments
- Is my current plan working?
Do we have a urate target, and am I reaching it?
- Would a newer option fit me?
Is there a reason one of the newer medicines might suit me, or not, given my kidneys, heart, and other medicines?
- Should I look at a clinical trial?
Am I a possible fit, and what would joining involve?
- Can we look at ClinicalTrials.gov together?
The US registry at ClinicalTrials.gov lists studies by condition and location.
- What about my heart risk?
Given gout and heart research, is there anything we should check?
- What should I watch for?
If we change anything, what side effects or signs should make me call?
More questions are on Questions for your clinician and the printable questions sheet. For how we got here, see A short history of gout.
Sources
- 2020 American College of Rheumatology Guideline for the Management of Gout
- FitzGerald JD, et al. Treat-to-target strategy (strong recommendation), and IL-1 blockers for flares (conditional). Accessed October 12, 2026.
- Association between gout flare and subsequent cardiovascular events among patients with gout
- Cipolletta E, et al. JAMA, 2022. Observational; association, not causation. Accessed October 12, 2026.
- Relationship of interleukin-1β blockade with incident gout and serum uric acid levels
- Solomon DH, et al. Annals of Internal Medicine. Exploratory analysis of the CANTOS trial (Ridker PM, et al. N Engl J Med 2017). Accessed October 12, 2026.
- FDA approval letter: Lodoco (colchicine)
- 2023 approval to reduce cardiovascular risk. Supporting review documents cite LoDoCo2 and COLCOT. Accessed October 12, 2026.
- Colchicine in acute myocardial infarction (CLEAR SYNERGY)
- New England Journal of Medicine, 2024. Accessed October 12, 2026.
- The genetics of gout: towards personalised medicine?
- Dalbeth N, Stamp LK, Merriman TR. BMC Medicine, 2017. SLC2A9, ABCG2, allopurinol response, and HLA-B*5801. Accessed October 12, 2026.
- FDA supplement approval letter: Ilaris (canakinumab) for gout flares
- 2023. Accessed October 12, 2026.
- FDA label: Kineret (anakinra), indications
- openFDA drug label. Accessed October 12, 2026.
- Sobi: complete response letter from FDA for NASP
- Company press release, June 26, 2026. Accessed October 12, 2026.
- Sobi: topline results from the phase 3 REDUCE 2 study of pozdeutinurad
- Company press release, May 21, 2026, and NCT06439602. Accessed October 12, 2026.
- Mochida and Fuji Yakuhin: approval of dotinurad (Urece) in Japan
- Company announcement in Japanese, January 23, 2020. Trial status from NCT07089875 and NCT07089888. Accessed October 12, 2026.
- JW Pharmaceutical: phase 3 results for epaminurad
- Company press release, August 11, 2026, and NCT05815901. Accessed October 12, 2026.
- Korea Biomedical Review: LG Chem drops late-stage gout drug
- March 28, 2025, and NCT05586971 (completed). Accessed October 12, 2026.
See also the site-wide sources.