SGLT-2 inhibitors reduced gout flares in patients with diabetes, gout

New users of sodium-glucose cotransporter-2 (SGLT-2) inhibitors had about half the risk of an ED visit or hospitalization for a gout flare as matched patients taking dipeptidyl peptidase-4 inhibitors, a cohort analysis found.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors may reduce recurrent gout flares and related ED visits and hospitalizations compared to treatment with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with gout and diabetes, a study found.

Researchers propensity score-matched 8,150 patients with both gout and type 2 diabetes who were new users of a SGLT-2 or DPP-4 inhibitor from January 2014 to June 2022. The primary outcome was recurrent gout flare counts from a variety of medical records. Secondary outcomes included myocardial infarction and stroke. Rates of genital infections (positive control) and osteoarthritis (negative control) were also assessed. Results were published July 24 by Annals of Internal Medicine.

SGLT-2 inhibitors were associated with a significantly lower rate of recurrent gout flares overall and of flares requiring an ED visit or hospitalization. After propensity score matching, the flare rate was 52.4 events per 1,000 person-years with SGLT-2 inhibitors versus 79.7 events per 1,000 person-years with DPP-4 inhibitors, for a rate ratio (RR) of 0.66 (95% CI, 0.57 to 0.75) and a rate difference (RD) of −27.4 (95% CI, −36.0 to −18.7) per 1,000 person-years. The corresponding RR and RD for gout-related ED visits and hospitalizations were 0.52 (95% CI, 0.32 to 0.84) and −3.4 (95% CI, −5.8 to −0.9) per 1,000 person-years, respectively.

The study also found that SGLT-2 inhibitor use was associated with a reduction in myocardial infarction, with a hazard ratio (HR) and RD of 0.69 (95% CI, 0.54 to 0.88) and −7.6 (95% CI, −12.4 to −2.8) per 1,000 person-years. For stroke, the HR was 0.81 (95% CI, 0.62 to 1.05). Risk for genital infection was higher in those who started SGLT-2 inhibitors (HR, 2.15; 95% CI, 1.39 to 3.30) but no difference was seen in risk for osteoarthritis (HR, 1.07; 95% CI, 0.95 to 1.20).

According to the authors, SGLT-2 inhibitors could have a much needed ability to simultaneously reduce recurrent gout flares and coronary sequelae in patients with gout and type 2 diabetes. “Given the pleiotropic cardiometabolic benefits associated with [SGLT-2 inhibitors] among patients with type 2 diabetes, this class of medications may be a particularly attractive addition to our current urate-lowering therapies to simultaneously address the high burden of gout and cardiometabolic sequelae,” they wrote.