Zhou Jiandong, Liu Xuejin, Chou Oscar Hou-In, Li Lifang, Lee Sharen, Wong Wing Tak, Zhang Qingpeng, Chang Carlin, Liu Tong, Tse Gary, Jing Fengshi, Cheung Bernard Man Yung
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China.
Rheumatology (Oxford). 2023 Apr 3;62(4):1501-1510. doi: 10.1093/rheumatology/keac509.
The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) vs dipeptidyl peptidase-4 inhibitors (DPP4I) on the risk of new-onset gout remains unknown. This study aims to compare the effects of SGLT2I against DPP4I on gout risks.
This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus treated with SGLT2I or DPP4I between 1 January 2015 and 31 December 2020 in Hong Kong. The study outcomes are new-onset gout and all-cause mortality. Propensity score matching (1:1 ratio) between SGLT2I and DPP4I was performed. Univariable and multivariable Cox regression models were conducted. Competing risks models and multiple approaches based on the propensity score were applied.
This study included 43 201 patients [median age: 63.23 years old (Interquartile range, IQR): 55.21-71.95, 53.74% males; SGLT2I group: n = 16 144; DPP4I group: n = 27 057] with a median follow-up of 5.59 years (IQR: 5.27-5.81 years) since initial drug exposure. The incidence rate of developing gout [Incidence rate (IR): 2.5; 95% CI: 2.2, 2.9] among SGLT2I users was significantly lower than DPP4I users (IR: 5.2; 95% CI: 4.8, 5.8). SGLT2I was associated with 51% lower risks of gout (HR: 0.49; 95% CI: 0.42, 0.58; P-value < 0.0001) and 51% lower risks of all-cause mortality (HR: 0.49; 95% CI: 0.42, 0.58; P-value < 0.0001) after adjusting for significant demographics, past comorbidities, medications and laboratory results. The results remained consistent on competing risk and other propensity score approaches.
SGLT2I use was associated with lower risks of new gout diagnosis compared with DPP4I use.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2I）与二肽基肽酶-4抑制剂（DPP4I）对新发痛风风险的影响尚不清楚。本研究旨在比较SGLT2I与DPP4I对痛风风险的影响。
这是一项基于人群的回顾性队列研究，研究对象为2015年1月1日至2020年12月31日在香港接受SGLT2I或DPP4I治疗的2型糖尿病患者。研究结局为新发痛风和全因死亡率。对SGLT2I和DPP4I进行倾向评分匹配（1:1比例）。采用单变量和多变量Cox回归模型。应用竞争风险模型和基于倾向评分的多种方法。
本研究纳入43201例患者[中位年龄：63.23岁（四分位间距，IQR）：55.21-71.95，男性占53.74%；SGLT2I组：n = 16144；DPP4I组：n = 27057]，自首次药物暴露后的中位随访时间为5.59年（IQR：5.27-5.81年）。SGLT2I使用者中痛风的发病率[发病率（IR）：2.5；95%CI：2.2，2.9]显著低于DPP4I使用者（IR：5.2；95%CI：4.8，5.8）。在调整了重要的人口统计学特征、既往合并症、用药情况和实验室检查结果后，SGLT2I与痛风风险降低51%（HR：0.49；95%CI：0.42，0.58；P值<0.0001）和全因死亡率降低51%（HR：其0.49；95%CI：0.42，0.58；P值<0.0001）相关。在竞争风险和其他倾向评分方法中，结果保持一致。
与使用DPP4I相比，使用SGLT2I与新发痛风诊断风险较低相关。
