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SGLT2 inhibitors may lower risk of gout in diabetes patients

January 13, 2020

By Megan Brooks

NEW YORK (Reuters Health) - Treatment with a sodium-glucose cotransporter-2 (SGLT2) inhibitor may protect against gout in adults with type 2 diabetes, new research suggests.

"Identifying medications that reduce a person's risk of gout has taken on new importance, since a commonly used medication (febuxostat) for gout was recently found to increase a person's risk of death," Dr. Michael Fralick, general internist at Sinai Health in Toronto, told Reuters Health by email.

SGLT2 inhibitors are used with diet and exercise to lower blood sugar in adults with type 2 diabetes.

"Our research team noticed that there were studies that showed SGLT2 inhibitors lower uric acid (and high uric acid can cause gout), but it was unknown whether the reduction in uric acid was large enough to reduce a person's risk of gout. That served as the motivation to conduct this study, and we were very excited to see that SGLT2 inhibitors were associated with an almost 40% reduction in a person’s risk of gout," said Dr. Fralick, who is also affiliated with the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston, where the study was conducted.

The researchers used a nationwide commercial insurance database to create a propensity-matched cohort of 119,530 patients newly prescribed a SGLT2 inhibitor and a like number newly prescribed a glucagon-like peptide-1 (GLP1) receptor agonist, with mean follow up of 302 days and 261 days, respectively.

The incidence of gout was significantly lower among patients prescribed an SGLT2 inhibitor (4.9 vs 7.8 events per 1000 person-years), with a hazard ratio of 0.64 (95% CI 0.57 to 0.72) and an absolute risk reduction of about three fewer adults with gout per 1000 person-years.

The findings were "robust" across sensitivity analyses, as well as in a cohort in which adults prescribed a dipeptidyl peptidase-4 (DPP4) inhibitor were the comparator group. The results provide empirical evidence that the reduction in uric acid levels with SGLT2 inhibitor therapy "may indeed be clinically meaningful," the researchers wrote in Annals of Internal Medicine.

They say the findings need to be replicated to "confirm whether the observed reduction in the rate of gout is a true effect of SGLT2 inhibitors or the result of unmeasured confounding or a chance finding."

If replicated, SGLT2 inhibitors "might be an effective class of medication for the prevention of gout for patients with diabetes or metabolic disorders," they conclude.

The study was funded by Brigham and Women's Hospital. The authors have no relevant disclosures.

SOURCE: Annals of Internal Medicine, online January 13, 2020.

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