Author's response to Letter.

Abstract

The letter by Lipsky and colleagues focuses on the strong recommendation against switching to pegloticase where serum urate (SU) > 6 mg/dL on current urate lowering treatment (ULT) for patients with mild disease, defined as infrequent attacks (<2 flares per year) and no tophi. In their critique of switching ULT to pegloticase for patients with mild disease activity, the authors refer to "Very Low" quality of evidence reviewed by the panel. In fact, the evidence presented to and reviewed by the Panel is rated as "Moderate" not "Very Low." (See Table 5.).