Natalie McCormick, PhD, from the Rheumatology and Allergy Clinical Epidemiology Research Center at Mass General Brigham, leads a groundbreaking study published in Diabetes Care that reveals the potential of sodium-glucose cotransporter 2 inhibitors (SGLT2i) to reduce medication needs for patients with both gout and type 2 diabetes. This study could signal a significant shift in how these co-occurring conditions are managed.
Gout, a painful form of inflammatory arthritis, affects over 12 million U.S. adults, with a significant prevalence among those aged 65 and older. The condition often coexists with cardiovascular, kidney, and metabolic disorders, complicating treatment regimens. Conventional urate-lowering therapies (ULTs) are typically prescribed to prevent gout flares but do not address these comorbidities, leading to a complex medication landscape for patients.
Exploring the Role of SGLT2 Inhibitors
SGLT2 inhibitors are primarily approved for managing type 2 diabetes, heart failure, and chronic kidney disease. However, their ability to lower serum urate levels and reduce the need for diuretics, which are a risk factor for gout flares, prompted researchers to explore their potential benefits in gout management. McCormick and her team questioned whether SGLT2i could decrease the reliance on conventional ULTs and acute flare medications such as NSAIDs, colchicine, and glucocorticoids.
The study emulated a randomized clinical trial using extensive population-based datasets, analyzing over 18,000 patients with both gout and type 2 diabetes. These patients initiated treatment with either SGLT2i, dipeptidyl peptidase 4 inhibitors (DPP-4i), or glucagon-like peptide 1 receptor agonists (GLP1-RA), while not currently using ULTs. Statistical techniques were employed to balance baseline characteristics across treatment groups, mimicking the effects of randomization.
Significant Findings and Implications
The results were compelling. Compared to DPP-4i, SGLT2i use was linked to a 38% lower probability of starting allopurinol, a common urate-lowering drug. Patients on SGLT2i also had fewer prescriptions for NSAIDs, colchicine, and high-dose glucocorticoids, and experienced fewer gout flares. Additionally, there was a notable reduction in the need for diuretic medications, particularly loop diuretics.
“SGLT2i use could reduce their exposure to NSAIDs and glucocorticoids, which often have adverse effects, by lowering their use of gout-related medications,” McCormick noted.
These findings suggest that SGLT2 inhibitors may streamline care for patients with gout and type 2 diabetes, reducing their medication burden and potentially improving their quality of life. The study also highlights the broader implications of using SGLT2i in managing complex comorbid conditions.
Future Research Directions
McCormick expressed interest in further exploring the concept of polypharmacy, defined as the regular use of five or more medications, which is prevalent among patients with gout. Understanding its implications and potential solutions could lead to better management strategies for this patient population.
The study, authored by McCormick alongside Chio Yokose, Deborah Wexler, Sharan Rai, Greg Challener, Ran Abuhasira, and Hyon Choi, was supported by grants from the National Institutes of Health. It marks a significant step forward in the intersection of rheumatology and diabetes care, offering a promising avenue for reducing medication complexity and improving patient outcomes.
For further details, the full study can be accessed here.
