Serum urate change among gout patients treated with sodium-glucose cotransporter type 2 inhibitors vs. sulfonylurea: A comparative effectiveness analysis.

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.
Competing Interests: Declaration of competing interest Dr. Januzzi is a Trustee of the American College of Cardiology, is a Director at Imbria Pharmaceuticals, has received grant support for clinical trial leadership from Abbott, Applied Therapeutics, Bristol Myers, HeartFlow Inc, Innolife and Roche Diagnostics, consulting income from Abbott, AstraZeneca, Bayer, Beckman-Coulter, Jana Care, Janssen, Novartis, Merck, and Quidel-Ortho, Roche Diagnostics, and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Bayer, CVRx, Intercept, Pfizer and Takeda outside the submitted work. Dr. Deborah Wexler serves on a data monitoring committee for Novo Nordisk outside the submitted work. Dr. Meghan Sise reports research funding from Gilead, Angion, Otsuka, Novartis, Cabaletta Bio, EMD-Serono and serving as a scientific advisory board member for Vera, Travere, Calliditas, Novartis, Mallinckrodt and a data monitoring committee member for Alpine Immunosciences all outside the submitted work. Dr. Hyon K. Choi reports research support from Ironwood and Horizon, and consulting fees from Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart.
(Copyright © 2024. Published by Elsevier Inc.)