Sodium glucose cotransporter 2 inhibitors and gout risk: a sequence symmetry analysis

• Published in: Clinical rheumatology 2023-09, Vol.42 (9), p.2469-2475
• Main Authors: Wood, David T., Waterbury, Nancee V., Lund, Brian C.
• Format: Article
• Language: English
• Subjects: Diabetes; Diabetes mellitus; GLP-1 receptor agonists; Glucagon; Glucagon-like peptide 1; Gout; Medicine; Medicine & Public Health; Original Article; Rheumatology; Sensitivity analysis; Sodium-glucose cotransporter; Symmetry; Thiazolidinediones
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-023-06647-z

Objective To examine the association between sodium-glucose cotransporter 2 inhibitors (SGLT2-I) and gout incidence in patients with diabetes is the objective. Method National administrative data from the United States Veterans Health Administration were used to identify patients initiated on SGLT2-I from 2012 to 2020. Sequence symmetry analysis was performed to contrast the number of patients with incident gout within the year following SGLT2-I initiation to the number within the year preceding initiation. Exposure counterfactual analyses examined the relationship between potential therapeutic alternatives to SGLT2-I and risk for gout. Results The primary outcome of incident gout was observed in 441 patients preceding SGLT2-I initiation and 273 patients following SGTL2-I (symmetry ratio (SR) = 0.62; 95% CI: 0.53–0.72). This finding remained consistent across multiple sensitivity analyses. A reduction in gout incidence was also observed in exposure counterfactual cohorts initiating dipeptidyl peptidase-4 inhibitor (SR = 0.67; 95% CI: 0.63–0.72) and thiazolidinediones (SR = 0.72; 95% CI: 0.65–0.79), but not glucagon-like peptide-1 receptor agonist (GLP1-RA) (SR = 0.93; 95% CI: 0.77–1.12). Conclusions The risk for incident gout was significantly reduced following SGLT2-I initiation. GLP1-RA had minimal to no impact on gout risk. Our findings support pleiotropic benefits of SGLT2-I use in patients with diabetes at elevated risk for gout. Key points • Early studies suggest SGLT2-inhibitors may decrease risk for gout • Our sequence symmetry analysis confirmed this observation • DPP4s and thiazolidinediones were also associated with lower gout risk • SLGT2 inhibitors may be beneficial in patients with diabetes at risk for gout