Sodium-glucose cotransporter-2 inhibitors (SGLT2is) can prevent recurrent gout flares, gout hospitalizations, as well as cardiovascular events in patients with type 2 diabetes and prevalent gout, a new study finds.
In a propensity-score matched comparison of 4075 patients initiating SGLT2i and 4075 patients initiating dipeptidyl peptidase 4 inhibitors (DPP-4i) for type 2 diabetes, gout flares occurred in 52.4 vs 79.7 per 1000 person-years, respectively. SGL2i vs DPP-4i users had a significant 34% lower risk of gout flares, Hyon K. Choi, MD, DrPH, of Massachusetts General Hospital in Boston, Massachusetts, and colleagues reported in the Annals of Internal Medicine. Gout flares requiring an emergency department visit or hospitalization occurred in 3.6 vs 7.0 per 1000 person-years, respectively. SGL2i users had a significant 48% lower risk of these hospital encounters for gout compared with DPP-4i users. These benefits were observed regardless of gout severity, sex, age group, use of urate-lowering therapy, and use of diuretics.
Myocardial infarction occurred in 16.0 vs 23.6 per 1000 person-years of the SGLT2i and DPP-4i groups, respectively. SGLT2i users had a significant 31% decreased risk for myocardial infarction, the investigators reported.
“Given the pleiotropic cardiometabolic benefits associated with SGLT2is 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,” Dr Choi’s team wrote.
Mean gout duration was 11.5 years. Approximately 90% of both groups had hypertension, 60% had ischemic heart disease, 25% had chronic kidney disease, 23% had heart failure, 17%-19% had stroke, myocardial infarction, and peripheral vascular disease, 13% had obesity, 12% had diabetic nephropathy, and 9% had atrial fibrillation.
The risk for genital infections was 2.2-fold higher for SGLT2i users compared with DPP-4i users.
In sensitivity analyses, SGLT2i users also had a significant 34% and 46% lower risk for gout flares compared with glucagon-like peptide 1 receptor agonist and metformin users, respectively.
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. Ann Intern Med. Published online July 24, 2023. doi:10.7326/M23-0724