Study Finds Potential Benefits of SGLT2 Inhibitors in Reducing Gout Flares, Cardiovascular Risks

“Sodium–glucose cotransporter-2 inhibitors (SGLT2is) decrease serum urate levels,” investigators of a recent study in the Annals of Internal Medicine wrote, “but whether this translates into prevention of recurrent flares among patients with gout and gout-primary emergency department (ED) visits or hospitalizations is unknown.”

The goal of the study was to assess gout flares and cardiovascular events in patients with gout who begin treatment with SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is), an alternative second-line medication for glucose control unrelated to serum urate levels or cardiovascular risk.

The investigators employed a propensity score-matched study design using a general population database spanning from January 2014 to June 2022. The primary outcome measured was recurrent gout flare counts, ascertained through various medical records, including ED visits, hospitalizations, outpatient visits, and medication dispensing records. Secondary outcomes included myocardial infarction and stroke, with genital infection as a positive control and osteoarthritis encounters as a negative control. The data analysis employed Poisson and Cox proportional hazards regressions, and the primary analysis included 1:1 propensity score matching, with sensitivity analysis using overlap weighting.

Patients who initiated treatment with SGLT2is experienced significantly fewer gout flares compared with those who started with DPP-4is (rate ratio, 0.66; 95% CI, 0.57-0.75). Moreover, SGLT2i initiators also showed a decreased risk of gout-primary ED visits and hospitalizations.

Furthermore, the study demonstrated that SGLT2is may offer cardiovascular benefits to gout patients. The risk of myocardial infarction was notably lower among SGLT2i initiators (hazard ratio, 0.69; 95% CI, 0.574-0.88). While the difference in the risk of stroke was not statistically significant, the findings suggest a trend toward cardiovascular protection. However, SGLT2is were found to be associated with a higher risk of genital infections.

The study provides compelling evidence that SGLT2is may hold promise as a new treatment avenue for patients with gout and comorbid type 2 diabetes. These medications not only reduce the frequency of gout flares but also exhibit potential cardiovascular benefits; however, they come with the trade-off of a higher risk of genital infections.