# Anti-Inflammatory and Survival Benefits of Dipeptidyl Peptidase 4 Inhibitors Among Patients with Gout, T2DM Patients and Chronic Kidney Disease

## TL;DR

This study suggests that DPP-4 inhibitors may reduce inflammation and uric acid levels in patients with gout, T2DM, and CKD, potentially improving survival.

## Contribution

The study explores the anti-inflammatory and survival benefits of DPP-4 inhibitors in a complex patient population with gout, T2DM, and CKD.

## Key findings

- DPP-4 inhibitors significantly reduced serum uric acid and hs-CRP levels.
- There was a trend toward improved survival in CKD patients treated with DPP-4 inhibitors.
- Fewer emergency room visits for gout attacks were observed in the DPP-4 inhibitor group.

## Abstract

Gout and type 2 diabetes mellitus (T2DM) often coexist and are associated
with chronic kidney disease (CKD) and increased mortality. Dipeptidyl
peptidase-4 (DPP-4) inhibitors, commonly used in T2DM, may offer
additional benefits, such as reducing inflammation and uric acid levels.
This study aimed to assess the impact of DPP-4 inhibitors on gout flare
frequency, serum uric acid (sUA) levels, and survival in patients with
gout, T2DM, and CKD.

A cross-sectional, retrospective, longitudinal study was conducted over 6
years between 2016 – 2022, including patients with gout and T2DM from
the largest healthcare provider in Israel. Patients were divided into
treatment and control groups based on DPP4-inhibitor status treatment.
The primary outcome was the number of gout arthritis attacks over 1
year, reflected by the number of emergency room visits. Secondary
outcomes included mean serum high-sensitive C-reactive protein (hs-CRP)
levels and survival rates over the study period.

DPP-4 inhibitor treatment significantly reduced sUA levels (5.2±1.3 mg/dL
vs. 5.9±2.2 mg/dL, p=0.05) and hs-CRP levels (0.50±0.19 mg/dL,
p<0.001). Kaplan-Meier survival analysis suggested a trend towards
improved survival in the DPP-4 inhibitor group (HR=0.834, 95% CI:
0.6–1.04, p=0.05), particularly among patients with chronic kidney
disease (CKD), although without statistical significance. The emergency
room visits due to gout attacks were fewer in the DPP-4 inhibitor group,
although this difference did not achieve statistical significance.

DPP-4 inhibitors may offer benefits beyond glycemic control in T2DM and
gout, including reduced sUA and hs-CRP levels and improved survival in
CKD patients. Larger, randomized trials are warranted to explore these
potential benefits.