Gout Flares and Mortality After Sodium-Glucose Cotransporter-2 Inhibitor Treatment for Gout and Type 2 Diabetes

Key Points Question What is the association between using sodium-glucose contransporter-2 inhibitors (SGLT2i) and the risk of recurrent gout flares among adults with gout and type 2 diabetes? Findings In this cohort study of 5931 patients with gout and type 2 diabetes, initiation of SGLT2i treatment was associated with 19% fewer recurrent gout flares and 29% lower mortality than initiation of active comparator treatments. Meaning These findings suggest that SGLT2i may reduce the burden of recurrent gout flares and narrow the mortality gap between patients with gout and the general population.

[1]  B. Cheung,et al.  Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes. , 2022, Rheumatology.

[2]  Hyon K. Choi,et al.  When underlying biology threatens the randomization principle — initial gout flares of urate-lowering therapy , 2022, Nature Reviews Rheumatology.

[3]  G. Filippatos,et al.  Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in heart failure with reduced ejection fraction: the EMPEROR-reduced trial , 2022, European heart journal.

[4]  N. Dalbeth,et al.  Risk of gout flares after COVID-19 vaccination: A case-crossover study , 2022, Seminars in Arthritis and Rheumatism.

[5]  J. Shieh,et al.  Association of Sodium-Glucose Transport Protein 2 Inhibitor Use for Type 2 Diabetes and Incidence of Gout in Taiwan , 2021, JAMA network open.

[6]  Tsong-Hai Lee,et al.  Colchicine Use and Risks of Stroke Recurrence in Acute Non-Cardiogenic Ischemic Stroke Patients: A Population-Based Cohort Study , 2021, Journal of personalized medicine.

[7]  B. Zinman,et al.  Empagliflozin and uric acid metabolism in diabetes: A post hoc analysis of the EMPA‐REG OUTCOME trial , 2021, Diabetes, obesity & metabolism.

[8]  J. Hallas,et al.  Sodium‐glucose cotransporter‐2 inhibitors and the risk of gout: A Danish population based cohort study and symmetry analysis , 2021, Pharmacoepidemiology and drug safety.

[9]  K. Khunti SGLT2 inhibitors in people with and without T2DM , 2020, Nature Reviews Endocrinology.

[10]  I. Petersen,et al.  Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records. , 2020, Diabetes care.

[11]  M. Kolber,et al.  Treat‐to‐Target in Gout Management? Comment on the Article by FitzGerald et al , 2020, Arthritis & rheumatology.

[12]  M. Packer Uric Acid Is a Biomarker of Oxidative Stress in the Failing Heart: Lessons Learned from Trials With Allopurinol and SGLT2 Inhibitors. , 2020, Journal of cardiac failure.

[13]  G. Collins,et al.  Prevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990–2017: A Systematic Analysis of the Global Burden of Disease Study 2017 , 2020, Arthritis & rheumatology.

[14]  M. Cowie,et al.  SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control , 2020, Nature Reviews Cardiology.

[15]  W. Taylor,et al.  The experience of a gout flare: a meta-synthesis of qualitative studies. , 2020, Seminars in arthritis and rheumatism.

[16]  G. Guyatt,et al.  2020 American College of Rheumatology Guideline for the Management of Gout , 2020, Arthritis care & research.

[17]  J. Jeon,et al.  SGLT2 inhibition modulates NLRP3 inflammasome activity via ketones and insulin in diabetes with cardiovascular disease , 2020, Nature Communications.

[18]  Seoyoung C. Kim,et al.  Assessing the Risk for Gout With Sodium–Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes , 2020, Annals of Internal Medicine.

[19]  K. Mahaffey,et al.  The effects of canagliflozin on gout in type 2 diabetes: a post-hoc analysis of the CANVAS Program , 2019 .

[20]  M. Kapetanovic,et al.  Cause‐Specific Mortality in Gout: Novel Findings of Elevated Risk of Non–Cardiovascular‐Related Deaths , 2019, Arthritis & rheumatology.

[21]  C. Bailey Uric acid and the cardio‐renal effects of SGLT2 inhibitors , 2019, Diabetes, obesity & metabolism.

[22]  L. Duley,et al.  Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial , 2018, The Lancet.

[23]  Fan Li,et al.  Addressing Extreme Propensity Scores via the Overlap Weights , 2018, American journal of epidemiology.

[24]  E. Hoorn,et al.  Effect of immediate and prolonged GLP‐1 receptor agonist administration on uric acid and kidney clearance: Post‐hoc analyses of four clinical trials , 2018, Diabetes, obesity & metabolism.

[25]  N. Oliver,et al.  Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis , 2018, JAMA.

[26]  S. Schneeweiss,et al.  Cardiovascular outcomes associated with canagliflozin versus other non-gliflozin antidiabetic drugs: population based cohort study , 2018, British Medical Journal.

[27]  E. Matteson,et al.  The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years , 2017, The Journal of Rheumatology.

[28]  A. Taniguchi,et al.  Stepwise dose increase of febuxostat is comparable with colchicine prophylaxis for the prevention of gout flares during the initial phase of urate-lowering therapy: results from FORTUNE-1, a prospective, multicentre randomised study , 2017, Annals of the rheumatic diseases.

[29]  J. Singh,et al.  Medication adherence among patients with gout: A systematic review and meta-analysis. , 2017, Seminars in arthritis and rheumatism.

[30]  Y. Tajiri,et al.  Different effects of linagliptin and sitagliptin on blood pressure and renal function in Japanese patients with type 2 diabetes mellitus , 2017, Diabetology International.

[31]  Hyon K. Choi,et al.  The unclosing premature mortality gap in gout: a general population-based study , 2017, Annals of the rheumatic diseases.

[32]  Jason P. Fine,et al.  Statistical Primer for Cardiovascular Research Introduction to the Analysis of Survival Data in the Presence of Competing Risks , 2022 .

[33]  Hyon K. Choi,et al.  Sleep Apnea and the Risk of Incident Gout: A Population‐Based, Body Mass Index–Matched Cohort Study , 2015, Arthritis & rheumatology.

[34]  F. Perez-Ruiz,et al.  Study for Updated Gout Classification Criteria: Identification of Features to Classify Gout , 2015, Arthritis care & research.

[35]  M. Davies,et al.  Effect of canagliflozin on serum uric acid in patients with type 2 diabetes mellitus , 2015, Diabetes, obesity & metabolism.

[36]  M. Doherty,et al.  Comorbidities in patients with gout prior to and following diagnosis: case-control study , 2014, Annals of the rheumatic diseases.

[37]  T. Nakanishi,et al.  SGLT2 inhibitor lowers serum uric acid through alteration of uric acid transport activity in renal tubule by increased glycosuria , 2014, Biopharmaceutics & drug disposition.

[38]  F. Becce,et al.  2016 updated EULAR evidence-based recommendations for the management of gout , 2014, Annals of the rheumatic diseases.

[39]  F. Becce,et al.  SAT0531 Updated Eular Evidence-Based Recommendations for the Management of Gout , 2014 .

[40]  M. Doherty,et al.  Optimizing current treatment of gout , 2014, Nature Reviews Rheumatology.

[41]  P. Lipsky,et al.  Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. , 2011, JAMA.

[42]  D. Rothenbacher,et al.  Frequency and risk factors of gout flares in a large population-based cohort of incident gout. , 2011, Rheumatology.

[43]  N. Dalbeth,et al.  Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. , 2006, The Journal of rheumatology.

[44]  H. Schumacher,et al.  Febuxostat compared with allopurinol in patients with hyperuricemia and gout. , 2005, The New England journal of medicine.

[45]  Lena Osterhagen,et al.  Multiple Imputation For Nonresponse In Surveys , 2016 .

[46]  D. Hunter,et al.  Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study. , 2006, The Journal of rheumatology.