Rasburicase is a genetically engineered enzyme. It causes uric acid to break down to allantoin which is more soluble, and easily excreted by the kidneys.
Though rasburicase is very effective at reducing uric acid levels, it is not approved for long term use. FDA approval is limited to counteracting the effects of chemotherapy in children over a maximum of 5 days.
There have been a small number of European studies of rasburicase and gout, but I am not aware of any proper clinical trials.
Tausche and Schroder comment in Annals of the Rheumatic Diseases that the main dilemma…
… is not the high cost but the missing approval by the FDA in severe tophaceous gout.
Of course, mass production might bring the cost down, but rasburicase has another drawback. It is administered intravenously, over a 30 minute period.
A similar drug, Puricase, is currently undergoing trials. FDA submission is expected late this year, or early next year.
The intention for both these drugs is that they will only be considered when other treatments, usually allopurinol, have failed or are inappropriate.
What are your views on rasburicase and gout?