SGLT2 inhibitors are tied to reduced gout risk in T2D

  • Fralick M & al.
  • Ann Intern Med
  • 14 ene. 2020

  • de Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Adults with type 2 diabetes (T2D) prescribed a sodium-glucose cotransporter-2 (SGLT2) inhibitor had lower subsequent gout rates than those prescribed a glucagon-like peptide-1 receptor agonist (GLP1-RA).

Why this matters

  • Adults with gout have ~30% higher rate of cardiovascular disease (CVD) and all-cause mortality compared with those without gout.
  • Febuxostat reduces gout attack risk but is linked to increased CVD risk vs allopurinol.

Study design

  • US commercial insurance database, March 2013-December 2017.
  • Gout rates were compared in propensity-matched patients with T2D and no prior/current gout newly initiating SGLT2 inhibitors (SGLT2is) or GLP1-RAs (n=119,530 per group).
  • Funding: Brigham and Women's Hospital.

Key results

  • Gout diagnoses per 1000 person-years: 4.9 with SGLT2i vs 7.8 with GLP1-RA. 
    • Adjusted HR, 0.64 (95% CI, 0.57-0.72).
  • Absolute rate difference between propensity score-matched SGLT2i and GLP1-RA groups:
    • −2.85 (95% CI, −3.59 to −2.12) per 1000 person-years.
    • Consistent regardless of age, sex, and baseline diuretic use.
  • In sensitivity analysis comparing new SGLT2i users with propensity score-matched new dipeptidyl peptidase-4 inhibitor users (97,442/group), HR for gout with SGLT2i was 0.66 (95% CI, 0.58-0.75).

Limitations

  • Propensity matching excludes some patients.
  • Incomplete baseline laboratory data.
  • Short follow-up (~280 days).