In patients with gout, initiation of treatment with sodium–glucose cotransporter-2 inhibitors (SGLT2is) for diabetes may reduce recurrent flares; reduce gout-primary emergency department (ED) visits and hospitalizations; and prevent major cardiovascular events, researchers report. “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,” conclude the authors.
Patients included in the propensity score–matched cohort study had both type 2 diabetes and gout and initiated SGLT2is or dipeptidyl peptidase 4 inhibitors (DPP-4is) during the 2014–22 period. The investigators looked for ED visits, hospitalizations, outpatient visits, and medication dispensing records in a general population database.
With a primary outcome of recurrent gout flare counts and several secondary outcomes, the study showed: “After propensity score matching, the flare rate was lower among SGLT2i initiators than DPP-4is initiators (52.4 and 79.7 events per 1000 person-years, respectively), with a rate ratio (RR) of 0.66 (95% CI, 0.57 to 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-primary ED visits and hospitalizations were 0.52 (CI, 0.32 to 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 to 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 to 1.05). Those who initiated SGLT2is showed higher risk for [the postive control] genital infection (HR, 2.15 [CI, 1.39 to 3.30]) and no altered risk for [the negative control] osteoarthritis encounter (HR, 1.07 [CI, 0.95 to 1.20]). Results were similar when propensity score overlap weighting was applied.”