Abstract

Background: Studies have shown that use of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors decreased serum uric acid concentrations.
Objective: To review the potential use of SGLT2 inhibitors for prevention of gout
Methods: Pub med search until January 5, 2023. Search terms included SGLT2 inhibitors, uric acid, gout, treatment, diabetes. Randomized trials, meta-analysis, and guidelines are reviewed.
Results: SGLT2 inhibitors decreased serum uric acid levels by an average 0.55mg/dl (95% CI, 0.62 to 0.48, P<0.001) compared with placebo or comparator drugs. The magnitude of reduction in serum uric acid with SGLT2 inhibitors was more pronounced with higher baseline serum uric acid levels and in patients without type 2 diabetes. The decrease in serum uric acid concentrations occurred as early as 3 days after administration of SGLT2 inhibitor, was dose-independent, and was stable during the duration of administration of SGLT2 inhibitors. Seven retrospective studies and 2 post-hoc analyses of large,
randomized trials showed that SGLT2 inhibitors reduced the risk of incident gout or the initiation of antigout medications by 11-63%, whereas only one retrospective study did not report any significant effect. Conclusion: SGLT2 inhibitors should be considered for gout prophylaxis in subjects with hyperuricemia. Randomized trials are needed to define the optimum and cost-effective use of SGLT2 inhibitors for gout prevention.

Keywords:SGLT2 inhibitors; Uric acid; Gout; Prevention; Type 2 diabetes; Heart failure