Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
TriNetX LLC, Cambridge, Massachusetts, USA.
Clin Ther. 2024 Nov;46(11):835-840. doi: 10.1016/j.clinthera.2024.06.021. Epub 2024 Jul 26.
This study aimed to evaluate the relative association between sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1Ra) with the incidence of gout in patients with type 2 diabetes (T2D) using real-world data.
We conducted a cohort study using data from TriNetX (an international federated database). We included patients commenced on metformin or insulin, either alone or with an SGLT2i or GLP-1Ra, at least 2 years prior to date of analysis. We propensity score matched (PSM) (1:1) for 26 relevant characteristics. Time to event analysis was performed to assess the incidence of gout, all-cause mortality (positive control), and herpes zoster infection (negative control) at 5 years following drug initiation.
Prior to PSM, the cohort numbers were as follows: metformin control, 1,111,449; SGLT2i with metformin, 101,706; GLP-1Ra with metformin, 110,180, insulin control, 1,398,066; SGLT2i with insulin, 68,697; and GLP-1Ra with insulin, 99,693. SGLT2i with metformin demonstrated a statistically significant decreased incidence of gout at 5 years compared to the metformin control cohort (HR 0.75 [95% CI 0.69-0.82], P < 0.0001). Similarly, SGLT2i with insulin demonstrated a statistically significant decreased incidence of gout at 5 years compared to the insulin control cohort (HR 0.83 [95% CI 0.74-0.92], P < 0.0001). Conversely, no significant disparity in gout incidence was observed between the use of GLP-1Ra and matched controls. Subgroup analysis showed an associated reduced incidence of gout with SGLT2i use compared to GLP-1Ra, in groups using metformin (HR 0.77 [95% CI 0.70-0.86], P < 0.0001) or insulin (HR 0.82 [95% CI 0.73-0.91)], P < 0.0001).
In this large-scale real-world study, SGLT2i use was associated with a lower incidence of gout in patients with T2D compared to both insulin and metformin controls. These findings suggest the potential of SGLT2i as a promising therapeutic option for treating gout in this population.
本研究旨在使用真实世界数据评估钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽-1 受体激动剂（GLP-1Ra）与 2 型糖尿病（T2D）患者痛风发病风险的相对关联。
我们使用 TriNetX（一个国际联合数据库）中的数据开展了一项队列研究。我们纳入了至少在分析日期前 2 年开始使用二甲双胍或胰岛素单独或联合 SGLT2i 或 GLP-1Ra 治疗的患者。我们进行了倾向性评分匹配（PSM）（1:1），匹配了 26 个相关特征。采用时间事件分析评估了药物起始后 5 年内痛风、全因死亡率（阳性对照）和带状疱疹感染（阴性对照）的发病情况。
在 PSM 之前，队列人数如下：二甲双胍对照组 1,111,449 例；二甲双胍联合 SGLT2i 组 101,706 例；二甲双胍联合 GLP-1Ra 组 110,180 例，胰岛素对照组 1,398,066 例；胰岛素联合 SGLT2i 组 68,697 例；胰岛素联合 GLP-1Ra 组 99,693 例。与二甲双胍对照组相比，SGLT2i 联合二甲双胍组在 5 年内痛风的发病风险显著降低（HR 0.75 [95%CI 0.69-0.82]，P < 0.0001）。同样，SGLT2i 联合胰岛素组在 5 年内痛风的发病风险也显著低于胰岛素对照组（HR 0.83 [95%CI 0.74-0.92]，P < 0.0001）。相反，GLP-1Ra 与匹配对照组在痛风发病风险方面没有显著差异。亚组分析显示，与 GLP-1Ra 相比，SGLT2i 组使用 SGLT2i 治疗的患者痛风发病风险降低，在使用二甲双胍（HR 0.77 [95%CI 0.70-0.86]，P < 0.0001）或胰岛素（HR 0.82 [95%CI 0.73-0.91]）的患者中也观察到这一结果，P < 0.0001）。
在这项大规模真实世界研究中，与胰岛素和二甲双胍对照组相比，SGLT2i 治疗与 T2D 患者痛风发病风险降低相关。这些发现表明 SGLT2i 作为治疗该人群痛风的一种有前途的治疗选择具有潜在作用。
