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

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A LETTER TO THE EDITOR to this article was published on 12 October 2023

Abstract

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

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Funding

This research was supported by the Iowa City VA Health Care System, Department of Pharmacy Services. Additional support was provided by the Health Services Research and Development Service, Department of Veterans Affairs (Dr. Lund, CIN 13-412).

Author information

Authors and Affiliations

  1. Department of Pharmacy Services, Omaha Veterans Affairs Medical Center, 4101 Woolworth Ave, Omaha, NE, 68105, USA

    David T. Wood

  2. Department of Pharmacy Services, Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA

    Nancee V. Waterbury & Brian C. Lund

  3. Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA

    Brian C. Lund

Authors
  1. David T. Wood
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  2. Nancee V. Waterbury
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  3. Brian C. Lund
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by David Wood, Brian Lund, and Nancee Waterbury. The first draft of the manuscript was written by David Wood, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to David T. Wood.

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Conflicts of interest

The authors declare they have no conflicts of interest.

Disclosure

None of these sponsors had any role in the study design, methods, analyses, and interpretation, or in preparation of the manuscript and the decision to submit it for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

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Wood, D.T., Waterbury, N.V. & Lund, B.C. Sodium glucose cotransporter 2 inhibitors and gout risk: a sequence symmetry analysis. Clin Rheumatol 42, 2469–2475 (2023). https://doi.org/10.1007/s10067-023-06647-z

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  • DOI: https://doi.org/10.1007/s10067-023-06647-z

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