Dr. Bernal
Clinical question: Do SGLT-2 inhibitors decrease gout flares in patients with type 2 diabetes and a known history of gout?
Background: Sodium–glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are known to decrease serum urate levels and the risk of incident gout. However, their role in secondary prevention of gout flares is unknown.
Study design: Propensity score–matched, new-user cohort study
Setting: British Columbia, Canada
Synopsis: Using a group of population-based, linked, administrative databases, the population of British Columbia was studied. 15,067 patients with gout and type 2 diabetes had first-time dispensing of SGLT-2 inhibitors or dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) between January 2014 and June 2022. After propensity matching, the study population included 8,150 patients. The primary outcome was gout flare counts as defined by emergency department (ED) visits, hospitalization, or outpatient visits for gout with appropriate medication dispensed within one week. SGLT-2 inhibitor use was associated with a 34% lower rate of recurrent gout compared with initiation of DPP-4 inhibitors. The rate of flares requiring an ED visit or hospitalization decreased by 48%. While SGLT-2 inhibitors were associated with higher rates of urinary tract infections, patients using SGLT-2 inhibitors also had a significantly lower rate of myocardial infarction. This was an observational study, which has an inherent potential for having an unmeasured confounder. As it was a population-based study, it is likely generalizable.
Bottom line: In patients with gout and type 2 diabetes, SGLT-2 inhibitors may decrease gout flares and offer cardioprotective effects compared to DPP-4 inhibitors.
Citation: McCormick N, Yokose C, et al. Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for recurrent gout flares and gout-primary emergency department visits and hospitalizations: a general population cohort study. Ann Intern Med. 2023;176(8):1067-80.
Dr. Bernal is a hospitalist at Duke University Hospital and a medical instructor in the department of medicine at Duke University School