Annals of Internal MedicineComparative Effectiveness of Sodium–Glucose Cotransporter-2 Inhibitors for Recurrent Gout Flares and Gout-Primary Emergency Department Visits and Hospitalizations

Exploring the Impact of SGLT2 Inhibitors on Gout Flares and Cardiovascular Events

This study aims to investigate the effect of sodium–glucose cotransporter-2 inhibitors (SGLT2is) on the prevention of recurrent gout flares, emergency department (ED) visits, and hospitalizations related to gout. The comparative effectiveness of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is) was analyzed in patients with gout and type 2 diabetes over a period extending from January 2014 to June 2022.

Study Design:

• Objective: Compare gout flares and cardiovascular events between patients with gout initiating SGLT2is versus DPP-4is.
• Design: Propensity score–matched, new-user cohort study.
• Setting: General population database, 1 January 2014 to 30 June 2022.
• Participants: Patients with gout and type 2 diabetes.
• Measurements: Outcomes assessed were recurrent gout flare counts, myocardial infarction, stroke, genital infection, and osteoarthritis encounter, utilizing Poisson and Cox proportional hazards regressions.

Key Findings:

• Lower flare rate among SGLT2i initiators compared to DPP-4i initiators (52.4 vs 79.7 events per 1000 person-years) with RR of 0.66 and RD of −27.4 per 1000 person-years.
• Reduced rate of gout-primary ED visits and hospitalizations (RR, 0.52; RD, −3.4 per 1000 person-years).
• Reduced hazard ratio (HR) and RD for myocardial infarction (HR, 0.69; RD, −7.6 per 1000 person-years).
• HR for stroke was 0.81 (CI, 0.62 to 1.05).
• Higher risk for genital infection (HR, 2.15) and no altered risk for osteoarthritis encounter (HR, 1.07).

Conclusion

• Among patients with gout, SGLT2is may reduce recurrent flares and gout-related ED visits and hospitalizations and may provide cardiovascular benefits.

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Did You Know?
Gout is associated with a higher risk of cardiovascular disease, and this study’s focus on the potential cardiovascular benefits of SGLT2is among gout patients represents a significant clinical interest.