SGLT2 inhibitors may reduce recurrent gout flares in type 2 diabetes patients

Sodium–glucose cotransporter-2 (SGLT2) inhibitors are known to decrease serum urate levels. However, it is unknown whether this translates into prevention of recurrent flares of gout and a reduction in gout-related emergency department visits or hospitalizations. A new study has examined this issue by comparing gout flares and cardiovascular events among type 2 diabetes patients with gout who were starting on a SGLT2 inhibitor versus a dipeptidyl peptidase 4 (DPP-4) inhibitor. DPP-4 inhibitors are an alternate class of second-line glucose-lowering agents that are not associated with serum urate levels or cardiovascular risk. The primary outcome in the study was recurrent gout flare counts, which were determined by emergency department, hospitalization, outpatient and medication dispensing records. Secondary outcomes included myocardial infarction and stroke. Genital infection (positive control) and osteoarthritis encounter (negative control) were also assessed. Results showed the following: After propensity score matching, the flare rate was lower among patients starting a SGLT2 inhibitor compared to a DPP-4 inhibitor (52.4 and 79.7 events per 1000 person-years, respectively), with a rate ratio (RR) of 0.66 (95% CI, 0.57–0.75) and a rate difference (RD) of −27.4 (CI, −36.0 to −18.7) per 1000 person-years. The corresponding RR and RD for gout-related emergency department visits and hospitalizations were 0.52 (CI, 0.32–0.84) and -3.4 (CI, -5.8 to -0.9) per 1000 person-years, respectively. The corresponding hazard ratio (HR) and RD for myocardial infarction were 0.69 (CI, 0.54–0.88) and -7.6 (CI, −12.4 to −2.8) per 1000 person-years. The HR for stroke was 0.81 (CI, 0.62–1.05). Patients who started a SGLT2 inhibitor showed a higher risk for genital infection (HR, 2.15 [CI, 1.39–3.30]) and no altered risk for osteoarthritis encounter (HR, 1.07 [CI, 0.95–1.20]). The authors conclude that in patients with type 2 diabetes and gout, SGLT2 inhibitors may reduce recurrent gout flares, as well as gout-related emergency department visits and hospitalizations. SGLT2 inhibitors may also provide cardiovascular benefits. Reference 1. McCormick N, Yokose C, Wei J, et al. Comparative effectiveness of sodium–glucose cotransporter-2 inhibitors for recurrent gout flares and gout-primary emergency department visits and hospitalizations. A general population cohort study. Published online July 25, 2023. (accessed August 8, 2023).

SGLT2 inhibitors may reduce recurrent gout flares in type 2 diabetes patients

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