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Lower Risk of Gout in Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors Versus Dipeptidyl Peptidase-4 (DPP4) Inhibitors in Type-2 Diabetes Patients: A Propensity Score-Matched Study with Competing Risk Analysis
27 Pages Posted: 24 Jan 2022
More...Abstract
Background: The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) versus dipeptidyl peptidase-4 inhibitors (DPP4I) on the risk of new gout diagnosis have not been explored. This study aims to compare the effects of SGLT2I against DPP4I on gout risks in a Chinese population.
Methods: This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus treated with SGLT2I or DPP4I between January 1 st , 2015 and December 31 st , 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 analysis models were conducted. Competing risks models and multiple approaches based on the propensity score were applied.
Patients: This study included 60996 patients (median age: 62.3 years old, 54.96% males; SGLTI group: n=21690; DPP4I group: n=39306).
Results: In the matched cohort, 1096 developed gout (IR: 2.52%) and 2195 died (IR: 5.05%). Univariable Cox regression showed that SGLT2I use was associated with lower risks of new diagnosis of gout (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.30-0.39; P-value<0.0001) and all-cause mortality (HR: 0.35; 95% CI: 0.32-0.39; P-value<0.0001) compared to DPP4I. The associated remained for both new diagnosis of gout (HR: 0.46; 95% CI: 0.37-0.57; P-value<0.0001) and all-cause mortality (HR: 0.38; 95% CI: 0.33-0.44; P-value<0.0001) after adjusting for significant demographics, past comorbidities, and non-SGLT2I/DPP4I medications. The risks of gout were lowered in each types of SGLT2I. The results were consistent on competing risk and other propensity score approaches analyses.
Conclusions: SGLT2I use was associated with lower risks of new gout diagnosis compared to DPP4I use.
Funding: None to declare.
Declaration of Interest: None to declare.
Ethical Approval: This study was approved by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (Reference No. 2018.309, 2018.643).
Keywords: SGLT2i, DPP4i, Gout, diabetes, Rheumatology, renal function
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