SGLT2 inhibitors may lower gout risk
Among patients with type 2 diabetes, using SGLT2 inhibitors may lower the risk for gout compared with other antidiabetic medications, according to study findings published in the Annals of Internal Medicine.
“Over 10 million adults across North America have gout,” Michael Fralick, MD, PhD, SM, FRCPC, a general internist at Sinai Health in Toronto and affiliated faculty member in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital, told Healio Primary Care. “When a gouty attack occurs it can be debilitating. Our study suggests that SGLT2 inhibitors may help to prevent gout among adults with diabetes.”
Previously, the gout medication febuxostat was found to increase the risk for cardiovascular mortality compared with another drug, allopurinol, demonstrating a need for more treatment options, according to researchers. Hyperuricemia is known cause of gout and is common among those with type 2 diabetes, they reported. While studies have shown that SGLT2 inhibitors have been associated with lower levels of serum uric acid, their effect on gout risk is unknown.
For the current study — which was conducted at the Brigham and Women’s Hospital in the division of pharmacoepidemiology and pharmacoeconomics — Fralick and colleagues used information from a national commercial insurance database to compare the rate of gout among adults with type 2 diabetes who were newly prescribed an SGLT2 inhibitor vs. those newly prescribed a GLP1 agonist.
Patients who were prescribed SGLT2 inhibitors were 1:1 propensity score-matched to those prescribed GLP1 agonists. Individuals who had a history of gout or received treatment for gout were excluded from the analysis.
Researchers identified 295,907 adults newly prescribed either medication. After propensity score matching, the analysis included 119,530 patients newly prescribed an SGLT2 inhibitor and 119,530 patients newly prescribed a GLP1 agonist.
Researchers observed a lower incidence of gout among patients in the SGLT2 inhibitor group (4.9 events per 1,000 person-years) vs. patients in the GLP1 agonist group (7.8 events per 1,000 person-years).
Compared with the GLP1 agonist group, the risk for gout was nearly 40% lower in the SGLT2 inhibitor group (HR = 0.64; 95% CI, 0.57-0.72).
Between the two groups, there was a rate difference of –2.9 (CI, –3.6 to –2.1) per 1,000 person-years.
“SGLT2 inhibitors are one of the most effective classes of medications for adults with diabetes,” Fralick said. “Our study suggests they may have the added benefit of reducing the risk of gout.”
However, the researchers noted that additional work is needed to confirm the association between SGLT2 inhibitors and gout.
“It is always important that new findings be repeated in a separate dataset/patient population,” Fralick explained. “Incidentally, a post-hoc analysis of a randomized trial was recently completed and published last month. It too suggests SGLT2 inhibitors are associated with a decreased risk of gout.” – by Erin Michael
Disclosures: Fralick reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.