SGLT2 inhibitors may reduce recurrent gout flares in patients with type 2 diabetes

Key takeaways:

• For patients with type 2 diabetes and gout, SGLT2 inhibitors were linked to a lower flare rate vs. DPP-4 inhibitors.
• SGLT2 inhibitors also reduced the risk for myocardial infarction and stroke.

SGLT2 inhibitors were associated with a reduction in recurrent flares and gout-related ED visits among patients with type 2 diabetes and gout, according to research published in Annals of Internal Medicine.

Researchers said the inhibitors also demonstrated cardiovascular benefits in this population.

The global burden of gout — the most common inflammatory arthritis — continues to increase, Natalie McCormick, PhD, a postdoctoral research fellow at Massachusetts General Hospital, and colleagues wrote. Suboptimal gout care and the “modern gout epidemic” have both contributed to high rates of recurrent flares.

“These gout flares have also been associated with transiently higher cardiovascular risk, and many cardiometabolic comorbidities accompany gout, including type 2 diabetes, metabolic syndrome, chronic kidney disease, and cardiovascular disease,” they wrote. “Thus, gout care interventions that can simultaneously address both gout flares and cardiometabolic risk would be ideal.”

SGLT2 inhibitors reduce serum urate levels, but it is not known if this translates into reduced ED visits, hospitalizations or recurrent flares for patients with gout, according to McCormick and colleagues. Therefore, they conducted a general population cohort study to compare cardiovascular events and gout flares in 8,150 patients with type 2 diabetes and gout who were taking SGLT2 inhibitors vs. dipeptidyl peptidase 4 (DPP-4) inhibitors — another glucose-lowering drug not associated with cardiovascular disease or serum urate levels.

The researchers used a group of population-based linked administrative databases — Population Data BC — that offer deidentified information on all dispensed prescriptions, hospital discharges and ED and outpatient medical visits with vital statistics data.

After propensity score matching, McCormick and colleagues reported that the flare rate was lower in patients taking SGLT2 inhibitors compared with those taking DPP-4 inhibitors at 52.4 vs. 79.7 events per 1,000 person-years (RR = 0.66; 95% CI, 0.57-0.75). The rate difference (RD) was -27.4 per 1,000 person-years (95% CI, –36 to –18.7).

In other words, taking SGLT2 inhibitors was linked to a 34% lower rate of recurrent gout flare — “the central goal of clinical gout care,” the researchers wrote.

Additionally, the RR and RD for hospitalizations and gout-primary ED visits were -3.4 (95% CI, –5.8 to –0.9) and 0.52 (95% CI, 0.32-0.84) per 1,000 person-years, respectively.

The researchers also noted that the corresponding HR for stroke was 0.81 (95% CI, 0.62-1.05) and the RD and HR for myocardial infarction were -7.6 (95% CI, –12.4 to –2.8) and 0.69 (95% CI, 0.54-0.88) per 1,000 person-years. SGLT2 inhibitor initiation was linked to a relative risk reduction in myocardial infarction of 31%.

“Given the pleiotropic cardiometabolic benefits associated with SGLT2 inhibitors 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,” McCormick and colleagues concluded.