1129: Effectiveness of sodium-glucose cotransporter type 2 inhibitors and urate-lowering agents in patients with gout: data from a single-center specialised clinic
Disclosure(s): No financial relationships with ineligible companies to disclose
Background/Purpose: Sodium-glucose cotransporter type 2 inhibitors (SGLT2I) proved substantial benefits in diabetes mellitus (DM), heart failure (HF) and kidney disease (KD). In pivotal trials, SGLT2Is reduced serum urate (SU) levels, but the evidence in patients with gout under other urate-lowering drugs (ULD) in clinical grounds is scarce. The objective is to evaluate the urate outcomes in patients with gout treated with SGLT2I and ULD in clinical practice.
Methods: Retrospective, single-center observational study, enrolling patients with gout from a crystal
arthritis specialised clinic. We selected those receiving combined treatment with ULD and SGLT2I, regardless of
the indication. Cases with no serum urate levels available in the 6 months before and
after combined treatment or starting renal replacement therapy were excluded. The main
variable of the study was SU level pre- and post-SGLT2I (mg/dL) statistically analized using
Wilcoxon test as a non parametric continuous variable. As secondary variables, we measured
the percentage achievement of SU target (< 6 mg/dL or < 5 mg/dL), the required allopurinol
dose (mg) and pre-estimated dose according to the Easy-Allo tool (mg) [PMID 38359899]. Results: Forty-six patients were included: median age 76 years (IQR 15.25), 82.6% men, with high
comorbidity (91.1% with DM, 58.7% with KD, 45.7% with HF) and 10 years (IQR 20) of gout
duration. As ULD, 66.7% (n=30) of patients were treated with allopurinol, 28.9% (n=13) with
febuxostat, and 4.4% (n=2) with benzbromarone. Regarding the SGLT2I, 58.7% (n=27) received
dapagliflozin, 30.4% (n=14) empagliflozin, and 10.9% (n=5) canagliflozin. ULD were initially
prescribed in 81.4% (n=35), while SGLT2I in the remaining 18.6% (n=8).
The target of SU < 6 mg/dL was achieved in 97.7% (95%CI 88.2-99.6%) of the patients, while
81.4% also reached < 5 mg/dL (95%CI 65.5-88.9%). The achievement of the < 5 mg/dL target
was unrelated to the first prescribed medication (ULD 81.3% vs SGLT2I 87.5%, p=1.000) or the
type of xanthine-oxidase inhibitor (allopurinol 79.3% vs febuxostat 91.7%, p=0.651).
The start of SGLT2I showed a median SU reduction of 0.85 mg/dL (IQR 3.02, p=0.001 for the
before-after comparison) [Image 1]. The SU reduction was observed regardless of being
already on ULD (median 0.80, IQR 2.90, p=0.021) or not (median 3.00, IQR 6.95, p=0.018) or of
changes in diuretics use (p=0.692).
No significant differences in allopurinol dose were found pre- and post-SGLT2I use but with a
trend toward a lower dosage than pre-estimated by the Easy-Allo tool [Image 2].
The use of SGLT2I showed significant reductions in fasting glucose, HbA1c, and C-reactive
protein levels, increased urine glucose excretion, and no differences in urine albumin and
glomerular filtration rate. We detected a significant reduction in diuretics use pre- and post-
SGLT2I (60.9% vs 54.3%, p < 0.001). Conclusion: The combination of SGLT2I and ULD in patients with gout in clinical practice achieved
significant SU level reductions and targets of SU < 6 mg/dL and < 5 mg/dL. A trend towards a
lower dosage requirement of allopurinol was noted, along with a reduced use of diuretics.
These promising results require confirmation by further intervention studies.
