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

Data from a large US claims database showed that SGLT2i use was associated with a 31% lower rate of ULT initiation. “This provides additional support for the use of SLGT2i therapy in patients with gout, particularly those with high-risk multimorbidity and polypharmacy,” Greg Challener, MD, postdoctoral researcher at the Rheumatology Clinical Epidemiology Research Center and in allergy, Massachusetts General Hospital, Boston. , said in his presentation of the data to the 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 to treat T2D. Since then, several other “flozins” have become available, and some have also received additional indications for heart failure and albuminuric chronic renal failure. Several previous studies associated the use of SGLT2i with lower rates of gout attacks as well as lower likelihood of developing gout firstly, even if 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 really at the point where this changes gout management per se, but it just helps us understand that (SGT2is) may have a role at some point, perhaps as a combination in more than one other agent. . Or, in some patients, it may really be enough if they’re already on SGLT2i and we don’t need to move to adding allopurinol. Maybe they have tophi, but they just started on an SGLT2i and they don’t light up. Typically, you would start these patients on allopurinol, but you could potentially just monitor them if they were just starting one of these agents (SGLT2i).

Asked to comment, session moderator J. Antonio Aviña-Zubieta, MD, PhD, head of the Division of Rheumatology at the University of British Columbia in Vancouver and senior scientist at Arthritis Research, Canada, said Medscape Medical News“What I can see happening when there is more evidence is that SGLT2is could be used or even become the standard of care as an adjuvant treatment to decrease flares, and thus decrease the risk of complications.”

Reductions in ULT, flare-ups and medical visits

The new study used health administrative data from the multicenter TriNetX Diamond Network of electronic health records and claims data from 92 health care sites with 212 million patients. Among people with both T2DM and gout who were not taking ULT at baseline, a total of 16,104 SGLT2 were initiated and 16,046 initiated glucagon-like peptide 1 (GLP-1) receptor agonists RA).

Propensity score matching was performed for demographics such as age, race, and gender; comorbidities; use of emergency, hospitalization and intensive care services; drugs; laboratories; and body mass index. This resulted in 11,800 individuals each in the SGLT2i and GLP-1 RA groups.

Over 5 years, 9.9% of patients in the SGLT2i group compared to 13.4% of those using the GLP-1 RA had initiated ULT, a significant difference with a relative risk (HR) of 0.69 (95% CI , 0.64-0.75). The risk of initiating colchicine for gout attacks was 4.7% with SGLT2i versus 6.0% for GLP-1 RA – also a significant difference with a relative risk 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, author of one of previous studies finding a reduction in gout attacks with SGLT2i, said: “many patients do not want to start gout treatment until they have more acute attacks…. So for many people, taking another pill to prevent an attack is a burden. But if you don’t treat it over time, attacks occur more often. So, can we still delay the start of therapy? If you don’t have as many flares, you reduce the burden of disease and polypharmacy, which I think is a potential long-term benefit if you already have an indication for diabetes treatment… This data supports that.”

Indeed, Challener said this data can help advise patients. “Taking your SGLT2i for your heart failure and diabetes also has some benefits for your gout, and we know there is also a cardiac benefit 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.