SGLT2 Inhibitors score over DPP-4 inhibitors in reducing recurrent Gout flare-ups in diabetes patients

Individuals with Gout and T2 diabetes who take Sodium-glucose cotransporter-2 inhibitors (SGLT2is) experienced fewer repeated flare-ups, gout-related emergency department visits, and hospitalizations, and also had cardiovascular advantages when compared with dipeptidyl peptidase 4 inhibitors (DPP-4is). The study was published in the journal 'Annals of Internal Medicine.'

Gout which is caused by the deposition of uric acid crystals in joints or in tissues around joints as a result of hyperuricemia is one of the very few rheumatic diseases that can be cured. There has been a steady increase in the incidence and prevalence of gout globally. Many guidelines have been recommended to improve the care for gout patients due to the increased economic and health care burden. Recent research revealed that SGLT2is lower serum urate levels, but there is uncertainty if that translates to reduced recurrent flares among patients with gout and gout-primary emergency department (ED) visits or hospitalizations. Hence researchers led by C. Yokose, J. Wei, et al conducted a study to compare gout flares and cardiovascular events among patients with gout under SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is). 

A propensity score–matched, new-user cohort study was carried out by collecting information from the general population database from 1 January 2014 to 30 June 2022 on patients with gout and type 2 diabetes. Recurrent gout flare counts determined by ED, hospitalization, outpatient, and medication dispensing records were the main result. Myocardial infarction and stroke were also investigated as secondary outcomes, along with vaginal infection (positive control) and osteoarthritis encounter (negative control). With 1:1 propensity score matching (main analysis) and overlap weighting (sensitivity analysis), Poisson and Cox proportional hazards regressions were employed.

Key findings: 

• There was a reduced flare rate among SGLT2i initiators than DPP-4i initiators, with a rate ratio (RR) of 0.66 and a rate difference (RD) of −27.4) per 1000 person-years after propensity score matching. 
• The corresponding RR and RD for gout-primary ED visits and hospitalizations were 0.52 and −3.4 per 1000 person-years, respectively.
• The corresponding hazard ratio (HR) and RD for myocardial infarction were 0.69  and −7.6 per 1000 person-years; the HR for stroke was 0.81.
• Gout patients under SGLT2is showed a higher risk for genital infection and no altered risk for osteoarthritis encounters.
• Results were similar when propensity score overlap weighting was applied. 

Thus, SGLT2is lowered recurrent flares and gout-primary ED visits and hospitalizations among Gout patients having diabetes and also provide cardiovascular benefits.

Further reading: Comparative Effectiveness of Sodium–Glucose Cotransporter-2 Inhibitors for Recurrent Gout Flares and Gout-Primary Emergency Department Visits and Hospitalizations. https://doi.org/10.7326/M23-0724.