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Chio Yokose, MD, MSc

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Sodium-glucose cotransporter type 2 (SGLT2) inhibitors, a common drug class in the management of cardiometabolic and diabetic conditions, may improve treatment outcomes for gout and its common comorbidities, according to a new review. It is said that there is a sex.1

A multinational team of researchers recently demonstrated that the mechanism of SGLT2 inhibition in arthritis patients may provide anti-inflammatory effects while further reducing the risk of cardiovascular and renal outcomes in such patients. We have published a review paper that suggests this. This drug class has already been shown. treat.

A study team led by Chio Yokose, MD, of the Rheumatology and Allergy Clinical Epidemiology Research Center (RACER) at Massachusetts General Hospital’s Mongan Institute, described the characteristics of gout and its most common comorbidities. The researchers noted that gout is the most common type of inflammatory arthritis worldwide and is generally associated with “painful, recurrent flare-ups…and an increased risk of temporary cardiovascular events.” .

The condition is also associated with an increased risk of type 2 diabetes, chronic kidney disease (CKD), and other cardiovascular diseases, Yokose and colleagues explained.

“These comorbidities, which may be combined with the inflammation associated with gout flares, contribute to persistent early gout mortality, independent of serum uric acid levels and traditional cardiovascular risk factors.” says the research team. “Better implementation of standard gout treatments may improve gout outcomes, but reducing mortality requires deliberate efforts to address cardiovascular risks in gout patients.” Probability is high.”

With this latter sentiment in mind, the research team suggested SGLT2 inhibitors as an “attractive treatment option for gout.” Drug Class – Optional forms including Empagliflozin (Jardiance). Since 2016, dapagliflozin (Farxiga); canagliflozin (Invokana); and ertugliflozin (Stegralo) have received approximately more than a dozen indications through the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes.2risk of cardiovascular events including heart failure3C.K.D.Four

Yokose et al. pointed to the multifactorial benefits of SGLT2 inhibition in gout patients, addressing not only gout-related morbidity but also cardiometabolic and renal risks.1 The researchers found that this drug class lowered serum uric acid concentrations, a major factor in gout incidence and severity, “without appreciably increasing the risk of bizarre gout flares,” leading to increased risk of incident gout flare-ups. and has been shown to reduce the risk of recurrence. This latter benefit would suggest a correlation between the anti-inflammatory effects observed in patients treated for cardiometabolic renal disease and similar effects in rheumatoid patients.

This is not the first analysis to consider the potential role of the SGLT2 inhibitor class in gout management. Research presented at the European League for Rheumatology (EULAR) 2023 Congress last May showed that starting SGLT2 inhibitors was associated with higher risk compared to other drug classes, including DPP-4 inhibitors (hazards). The risk of developing gout was shown to be significantly reduced in patients with type 2 diabetes.ratio [HR]0.54; 95% CI, 0.39 – 0.74), GLP-1 receptor agonists (HR, 0.39; 95% CI, 0.24 – 0.64), and sulfonylureas (HR, 0.61; 95% CI, 0.46 – 0.80).Five

Still, these promising clinical data make it clear that researchers are still trying to understand the urate-lowering and anti-gout effects of SGLT2 inhibitors, Yokose and colleagues noted.1 They suggested that such a mechanism may be due to the enhancement of uricosuria and anti-inflammatory pathways upon SGLT2 inhibition.

Still, the dynamic drug class appears to have a promising role in gout.

“Although additional research is needed to determine the role of SGLT2 inhibitors in the management of gout, available evidence suggests that these drugs may improve outcomes for gout patients. ‘ concluded the researchers.

References

  1. Yokose C., McCormick N., Abhishek A. other. Clinical benefits of sodium-glucose cotransporter type 2 inhibitors in patients with gout. Nat Rev Rheumatol 20, 216–231 (2024). https://doi.org/10.1038/s41584-024-01092-x
  2. Kunzmann K. FDA approves Pfizer and Merck’s ertugliflozin for type 2 diabetes. HCP Live. Published December 20, 2017. https://www.hcplive.com/view/fda-approves-pfizer-and-mercks-ertugliflozin-for-type-2-diabetes
  3. Campbell P. Dapagliflozin has been approved to reduce the risk of hospitalization for heart failure. HCP Live. Published October 21, 2019. https://www.hcplive.com/view/fda-expands-dapagliflozin-label-to-include-reducing-risk-of-cv-death-in-heart-failure
  4. Campbell P. Empagliflozin (Jardiance) receives US FDA approval for CKD. HCP live. Published September 22, 2023. https://www.hcplive.com/view/empagliflozin-jardiance-receives-ckd-approval-from-us-fda
  5. Campbell P. For people with diabetes, starting an SGLT2 inhibitor may reduce the risk of gout. HCP Live. Published June 2, 2023. https://www.hcplive.com/view/for-people-with-diabetes-sglt2-inhibitor-could-lower-gout-risk

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