SGLT-2 inhibitors reduce gout flares and offer CV benefits among patients with type 2 diabetes and gout: Study

Canada: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may reduce gout flares and cardiovascular events in patients with gout, a recent study published in Annals Of Internal Medicine has shown. SGLT2 inhibitors are a class of medications commonly used for the treatment of type 2 diabetes. 

"Among patients with gout, SGLT2 inhibitors may reduce recurrent flares and gout-primary ED (emergency department) visits and hospitalizations and may provide cardiovascular benefits," the researchers reported. 

Gout is a painful and inflammatory form of arthritis caused by the buildup of uric acid crystals in the joints. SGLT2is have previously been shown to decrease serum urate levels, which are linked to gout development. However, until now, it was unclear whether this reduction in serum urate levels would translate into a lower risk of recurrent gout flares and related complications.

Researchers conducted a propensity score-matched, new-user cohort study using a general population database spanning from January 2014 to June 2022. The study included patients with gout and type 2 diabetes, comparing those initiating SGLT2is with those starting dipeptidyl peptidase 4 inhibitors (DPP-4is), another second-line glucose-lowering agent not associated with serum urate levels or cardiovascular risk.

The primary outcome assessed was the number of recurrent gout flares, identified through emergency department visits, hospitalizations, outpatient visits, and medication dispensing records. Secondary outcomes included cardiovascular events, such as myocardial infarction and stroke. The study also assessed positive and negative controls: genital infection (positive control) and osteoarthritis encounter (negative control).

● After propensity score matching, the study found that patients who initiated SGLT2is had a lower gout flare rate compared to those starting DPP-4is.

● The rate ratio (RR) was 0.66 (95% CI, 0.57 to 0.75), and the rate difference (RD) was -27.4 (CI, -36.0 to -18.7) per 1000 person-years.

● The risk of gout-primary emergency department visits and hospitalizations was also lower in the SGLT2i initiators, with a corresponding RR of 0.52 (CI, 0.32 to 0.84) and an RD of -3.4 (CI, -5.8 to -0.9) per 1000 person-years.

● The study revealed potential cardiovascular benefits associated with SGLT2i use. The hazard ratio (HR) for myocardial infarction was 0.69 (CI, 0.54 to 0.88), and the RD was -7.6 (CI, -12.4 to -2.8) per 1000 person-years.

● The HR for stroke was 0.81 (CI, 0.62 to 1.05).

● It's essential to note that those who initiated SGLT2is showed a higher risk for genital infection (HR, 2.15 [CI, 1.39 to 3.30]), while no altered risk was observed for osteoarthritis encounters (HR, 1.07 [CI, 0.95 to 1.20]).

The study's findings suggest that SGLT2is may hold promise as a potential therapeutic option for patients with gout. Not only did these medications show potential in reducing recurrent gout flares and related hospital visits, but they also appeared to provide cardiovascular benefits. However, researchers acknowledge that further investigations are needed to fully understand the mechanisms and long-term effects of SGLT2i use in patients with gout.

As gout can severely impact patients' quality of life and lead to significant disability if left untreated, these findings may pave the way for new approaches to managing gout in patients with type 2 diabetes. Healthcare professionals should continue to carefully assess the individual needs of their patients and consider the potential benefits and risks of SGLT2i therapy to make informed treatment decisions.

Reference:

McCormick, N., Yokose, C., Wei, J., Lu, N., Wexler, D. J., Aviña-Zubieta, J. A., De Vera, M. A., Zhang, Y., & Choi, H. K. (2023). 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. Annals of Internal Medicine. https://doi.org/10.7326/m23-0724.