medwireNews: People with type 2 diabetes who are treated with sodium-glucose cotransporter (SGLT)2 inhibitors are less likely to develop gout than those given glucagon-like peptide (GLP)-1 receptor agonists, researchers report.
“Although SGLT2 inhibitors lower serum uric acid levels, their effect on reducing gout risk is unknown,” say Michael Fralick (Brigham and Women's Hospital, Boston, Massachusetts, USA) and fellow investigators. They note that SGLT2 inhibition results in glycosuria, which causes uric acid secretion in the urine, but GLP-1 receptor agonists do not influence uric acid levels, making them “an ideal comparator.”
The team used a US claims database to evaluate the incidence of gout among 239,060 individuals initiating treatment with an SGLT2 inhibitor or a GLP-1 receptor agonist for type 2 diabetes between 2013 and 2017. The average age was 54 years, and approximately half (52%) were women.
In all, 0.41% of 119,530 people in the SGLT2 inhibitor group were diagnosed with gout over an average follow-up of 302 days, compared with 0.56% of 119,530 propensity-matched patients in the GLP-1 receptor agonist group during a mean follow-up of 261 days.
These results translated into incidence rates of 4.9 versus 7.8 events per 1000 person–years and a significant 36% reduction in gout risk among patients taking SGLT2 inhibitors.
Fralick and team note that these results remained consistent regardless of age, sex, and baseline diuretic use in subgroup analyses, and similar findings were observed when another class of diabetes medication – dipeptidyl peptidase-4 inhibitors – was used as the comparator in place of GLP-1 receptor agonists.
These findings “provide empirical evidence that the reduction in uric acid levels [seen with SGLT2 inhibitors] may indeed be clinically meaningful,” write the study authors in the Annals of Internal Medicine.
“Future studies are necessary to confirm our findings, and if replicated, SGLT2 inhibitors might be an effective class of medication for the prevention of gout for patients with diabetes or metabolic disorders,” they add.
The researchers point out that their investigation “was predominantly composed of middle-aged adults” and excluded individuals with a history of gout, and therefore they “anticipate that the effect sizes may be different in older patients at higher baseline risk for gout.”
“[S]ubsequent observational studies in patients with prevalent gout and in those with a higher baseline risk for gout […] will be particularly important to determine whether the magnitude of potential benefit we identified represents an underestimate,” they say.
The team adds that “[l]ogically, patients with hyperuricemia and higher serum uric acid levels at baseline have a greater potential for reducing uric acid levels,” and if this is proven to be the case, SGLT2 inhibitors may represent a treatment option for people with hyperuricemia, perhaps even for those without diabetes.
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