Changsha, China—A study involving UK patients offers additional data that SGLT2i can lower the risk of recurrent gout flares among adults with gout and T2D.

In a cohort study published in JAMA Network Open, the study team from Central South University in Changsha, China, found that initiation of SGLT2i treatment was associated with 19% fewer recurrent gout flares and 29% lower mortality than initiation of active comparator treatments.

“Recurrent flares are the hallmark of clinical manifestation of gout,” the researchers write, in explaining why they embarked on the study. “Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with a lower risk of incident gout; however, their association with recurrent flares is unknown.”

The study examined the association of SGLT2i vs active comparators—glucagonlike peptide-1 receptor agonists [GLP-1 RA] or dipeptidyl peptidase-4 inhibitors [DPP-4i])—with the risk of recurrent gout flares and all-cause mortality among 5,931 patients with gout and T2D.

The population-based, retrospective cohort study was performed from January 1, 2013, to March 31, 2022, using a UK primary care database. Participants included patients with gout and T2D with visits to their general practitioners.

Defined as the primary outcome was the number of recurrent gout flares determined by reviewing codes and prescription records. Secondary outcomes were the first recurrent gout flare and all-cause mortality.

Participants had a mean age of 66 years, and 77.6% were men. For the study, 1,548 initiated SGLT2i treatment and 4,383 initiated treatment with active comparators.

Results indicate that the relative rate of the recurrent flares with SGLT2i versus active comparators was 0.79 (95% CI, 0.65-0.97). “Similar results were observed in the association of SGLT2i with the rate of recurrent flares when compared with DPP-4i or GLP-1 RA,” the authors write.

“For the first recurrent flare for SGLT2i vs active comparators, the rate difference was -8.8 (95% CI, -17.2 to -0.4) per 1,000 person-years and the hazard ratio was 0.81 (95% CI, 0.65-0.98). All-cause mortality per 1,000 person-years was 18.8 for SGLT2i and 24.9 for active comparators, with a rate difference of -6.1 (95% CI, -10.6 to -1.6) per 1,000 person-years and hazard ratio of 0.71 (95% CI, 0.52-0.97).”

Researchers suggest their findings confirm that SGLT2i use is associated with a lower risk of recurrent gout flares and mortality than their active comparators in patients with gout and T2D. “These findings further suggest that SGLT2i could help reduce the burden of recurrent gout flares and could also narrow the mortality gap between patients with gout and the general population,” they add.

Background information in the article notes that gout is the most common inflammatory arthritis and is on the increase. The report advises that current rheumatology guidelines recommend that patients with gout receive long-term therapy for lowering urate levels to achieve crystal dissolution, which is thought to help prevent recurrent gout flares. Yet, the authors point out, the management of gout is still suboptimal.

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