Language

English

Publication Date

6-1-2024

Journal

Seminars in Arthritis and Rheumatism

DOI

10.1016/j.semarthrit.2024.152441

PMID

38657403

PMCID

PMC11378417

PubMedCentral® Posted Date

6-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Objective: To investigate the serum urate (SU) change among gout patients initiating SGLT2i, and to compare with sulfonylurea, the second-most widely used glucose-lowering medication after metformin.

Methods: We conducted a cohort study of patients with gout and baseline SU >6 mg/dL who had SU measured within 90 days before and after SGLT2i or sulfonylurea initiation. Using multivariable linear regression, we compared SU change among SGLT2i initiators between those with and without diabetes and then compared SU change between SGLT2i and sulfonylurea.

Results: We identified 28 patients with gout initiating SGLT2i (including 16 with diabetes) and 28 patients initiating sulfonylurea (all with diabetes). Among SGLT2i initiators, the mean within-group SU change was -1.8 (95 % CI, -2.4 to -1.1) mg/dL, including -1.2 (-1.8 to -0.6) mg/dL and -2.5 (-3.6 to -1.3) mg/dL among patients with and without diabetes, respectively, with an adjusted difference between those with and without diabetes of -1.4 (-2.4 to -0.5) mg/dL. The SU did not change after initiating sulfonylurea (+0.3 [-0.3 to 1.0] mg/dL). The adjusted SU change difference between SGLT2i vs. sulfonylurea initiation was -1.8 (-2.7 to -0.9) mg/dL in all patients. The SU reduction persisted regardless of urate-lowering therapy or diuretic use and the presence of diabetes, chronic kidney disease, or heart failure.

Conclusion: Among patients with gout, SGLT2i was associated with a notable reduction in SU compared with sulfonylurea, with a larger reduction among patients without diabetes. With their proven cardiovascular-kidney-metabolic benefits, adding SGLT2i to current gout management could provide streamlined benefits for gout and its comorbidities.

Keywords

Humans, Gout, Male, Female, Uric Acid, Middle Aged, Sodium-Glucose Transporter 2 Inhibitors, Sulfonylurea Compounds, Aged, Diabetes Mellitus, Type 2, Hypoglycemic Agents, Treatment Outcome, Cohort Studies, gout, hyperuricemia, sodium-glucose cotransporter type 2 inhibitors, sulfonylurea, comparative effectiveness

Published Open-Access

yes

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