Comparative Performance of Sodium-Glucose Cotransporter-2 Inhibitors in Reducing Gout in Type 2 Diabetes

Among patients with type 2 diabetes (T2D), sodium-glucose cotransporter-2 (SGLT2) inhibitors dapagliflozin and empagliflozin vs canagliflozin show greater benefit in reducing gout, according to research results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

The current cohort study included 22,049 patients with T2D, aged between 18 and 89 years, who were incident users of a SGLT2 inhibitor (canagliflozin, n=3287; dapagliflozin, n=12,504; empagliflozin, n=6258). The study was conducted between 2013 and 2018, and all participants had 6 months of previous general practitioner enrollment before study entry. Study participants did not have gout or take gout medications, and were assessed for body mass index before initiation with SGLT2 inhibitors. Follow-up started from the date of the first SGLT2 inhibitor prescription and continued until incident diagnosis of gout, SGLT2 inhibitor switch, death, or study termination. Multivariable Cox proportional hazards regression was used to compare the 3 SGLT2 inhibitors for risk for gout development, adjusting for potential confounders.

Study results indicated that gout development was 1.57 times (adjusted hazard ratio [HR], 95% CI, 1.18-2.09) more likely among patients receiving canagliflozin. Patients receiving empagliflozin were 0.81 times (95% CI, 0.59-1.11) as likely to develop gout as those receiving dapagliflozin (HR, 1.0); however, the effect estimate did not achieve statistical significance. 

Researchers concluded that despite canagliflozin demonstrating superior gout risk reduction in previous studies, “the beneficial effects appeared to be strongest for dapagliflozin and empagliflozin, with no significant differences noted between the [2] of them.” Furthermore, they indicated that the “clinical relevance of the in vitro data on the potential anti-inflammatory effects of the various agents in this drug class” remains unclear. 

Reference

Vargas-Santos AB, Peloquin C, Kim S, Neogi T. Sodium-glucose co-transporter-2 inhibitors and the risk for gout – a comparison among canagliflozin, dapagliflozin and empagliflozin. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0660.