WASHINGTON, DC — The use of sodium-glucose cotransporter-2 (SGLT2i) inhibitors reduced the need for urate-lowering therapy (ULT) and gout therapy in people who had both type 2 diabetes (T2D) and gout. , new research has found.

Data from a large US database showed that SGLT2i use was associated with a 31% lower ULT initiation rate. “This provides further support for the use of SLGT2i therapy in patients with gout, particularly those with multimorbidity and high-risk polypharmacy,” Greg Challener, MD, postdoctoral fellow at the Rheumatology and Allergy Clinical Epidemiology Research Center, Massachusetts General Hospital, Boston. , said in his presentation of the data at American College of Rheumatology 2024 Annual Meeting.

The first agent in the SGLT2i class, dapagliflozin, was initially approved in the United States a decade ago for the treatment of T2D. Since then, several other “flozins” have become available, and some have also received additional indications for heart failure and chronic albuminuric kidney disease. More previous studies have linked SGLT2i use with lower rates of gout attacks as well as below the likelihood of developing gout first though not all studies have found this benefit.

Asked about the clinical implications of the new data, Challener said Medscape Medical News“I don’t think we’re quite at the point where this changes the management of gout itself, but it just helps us understand that (SGT2is) may have a role at some point, maybe as a combination over another agent.” . Or, in some patients, it may even be sufficient if they are already on an SGLT2i where we don’t have to switch to adding allopurinol. Maybe they have tophi, but have just been started on a SGLT2i and won’t light up. Typically, you would start those patients on allopurinol, but you might want to monitor them if they’ve just started one of these agents (SGLT2i).

Asked for comment, said session moderator J. Antonio Aviña-Zubieta, MD, PhD, chief of the Division of Rheumatology at the University of British Columbia, Vancouver, and senior scientist at Arthritis Research, Canada. Medscape Medical News“What I can see happening when there is more evidence is that SGLT2is can be used or even become standard of care as adjunctive therapy to reduce seizures and thereby decrease the risk of complications.”

Reductions in ULTs, flares, and healthcare visits

The new study used health administrative data from the multicenter TriNetX Diamond network of electronic medical records and claimed data from 92 healthcare sites with 212 million patients. Among those with T2D and gout not taking ULT at baseline, a total of 16,104 initiated SGLT2is and 16,046 initiated glucagon-like peptide 1 receptor agonists (GLP-1 RA).

Propensity score matching was performed for demographics, including age, race, and sex; comorbidities; use of emergency, inpatient and critical care services; medicines; laboratories; and body mass index. This generated 11,800 individuals each in the SGLT2i and GLP-1 RA groups.

Over 5 years, 9.9% of the SGLT2i group versus 13.4% of those using GLP-1 RA initiated ULT, a significant difference with a hazard ratio (HR) of 0.69 (95% CI, 0.64-0.75). The risk of colchicine initiation for gout attacks was 4.7% with SGLT2i versus 6.0% for GLP-1 RA – also a significant difference with a hazard ratio of 0.74 (0.65-0 ,83).

Medical visits for gout occurred in 28.0% versus 28.4% of patients, which also reached statistical significance (HR, 0.94; 95% CI, 0.89-0.99).

Aviña-Zubieta, an author of one of the previous studies Finding a reduction in gout attacks with SGLT2i, he said, “many patients do not want to start gout therapy until they start having more acute attacks…. So for many people, it’s a burden to take another pill to prevent an attack. But if you do not treat it in time, the attacks come more often. So can we delay the initiation of therapy any longer? If you don’t have as many flares, you lower the burden of disease and polypharmacy, which I think is a potential long-term benefit if you already have an indication for diabetes therapy… These data support that.”

Indeed, Challener said this data can help counsel patients. “Taking SGLT2i for heart failure and diabetes also provides some benefit for gout, and we know that there are also cardiac benefits when gout is controlled.”

Challener and Aviña-Zubieta had no disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape Medical News, and other work appears in the Washington Post, NPR’s Shots blog, and Diatribe. She’s on X @MiriamETucker.