• Ann. Intern. Med. · Feb 2020

    Assessing the Risk for Gout With Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Population-Based Cohort Study.

    • Michael Fralick, Sarah K Chen, Elisabetta Patorno, and Seoyoung C Kim.
    • Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Sinai Health System and the University of Toronto, Toronto, Ontario, Canada (M.F.).
    • Ann. Intern. Med. 2020 Feb 4; 172 (3): 186-194.

    BackgroundHyperuricemia is common in patients with type 2 diabetes mellitus and is known to cause gout. Sodium-glucose cotransporter-2 (SGLT2) inhibitors prevent glucose reabsorption and lower serum uric acid levels.ObjectiveTo compare the rate of gout between adults prescribed an SGLT2 inhibitor and those prescribed a glucagon-like peptide-1 (GLP1) receptor agonist.DesignPopulation-based new-user cohort study.SettingA U.S. nationwide commercial insurance database from March 2013 to December 2017.PatientsPersons with type 2 diabetes newly prescribed an SGLT2 inhibitor were 1:1 propensity score matched to patients newly prescribed a GLP1 agonist. Persons were excluded if they had a history of gout or had received gout-specific treatment previously.MeasurementsThe primary outcome was a new diagnosis of gout. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of the primary outcome and 95% CIs.ResultsThe study identified 295 907 adults with type 2 diabetes mellitus who were newly prescribed an SGLT2 inhibitor or a GLP1 agonist. The gout incidence rate was lower among patients prescribed an SGLT2 inhibitor (4.9 events per 1000 person-years) than those prescribed a GLP1 agonist (7.8 events per 1000 person-years), with an HR of 0.64 (95% CI, 0.57 to 0.72) and a rate difference of -2.9 (CI, -3.6 to -2.1) per 1000 person-years.LimitationUnmeasured confounding, missing data (namely incomplete laboratory data), and low baseline risk for gout.ConclusionAdults with type 2 diabetes prescribed an SGLT2 inhibitor had a lower rate of gout than those prescribed a GLP1 agonist. Sodium-glucose cotransporter-2 inhibitors may reduce the risk for gout among adults with type 2 diabetes mellitus, although future studies are necessary to confirm this observation.Primary Funding SourceBrigham and Women's Hospital.

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