# Combination of sodium-glucose cotransporter type 2 inhibitors and urate-lowering therapy in people with gout from a specialist clinic: a retrospective, single-center observational study

## TL;DR

Combining SGLT2 inhibitors with urate-lowering therapy in gout patients significantly lowers uric acid levels and helps achieve treatment goals.

## Contribution

Demonstrates the effectiveness of combining SGLT2 inhibitors and urate-lowering therapy in managing gout.

## Key findings

- Combined treatment reduced serum urate levels significantly, with 97.7% achieving levels below 6 mg/dL.
- There was a notable reduction in diuretic use after initiating combined treatment.
- Lower allopurinol doses were prescribed compared to predicted doses under combined treatment.

## Abstract

To evaluate the effectiveness of sodium-glucose cotransporter type 2 (SGLT2) inhibitors combined with traditional urate-lowering therapy (ULT) in people with gout, we conducted a retrospective, single-center observational study in a crystal arthritis clinic. Primary outcomes were reduction in serum urate (SU) levels and achievement of SU targets (<6 mg/dL and <5 mg/dL). We also compared prescribed allopurinol doses versus Easy-Allo-predicted doses and evaluated changes in diuretic use. The sample comprised 46 individuals (median age 75 years; 82.6% men) with a high prevalence of long-standing gout and comorbidities. Combined treatment was associated with a median SU reduction of 0.85 mg/dL (95% CI −1.7 to −0.1, p = 0.001). This effect was more pronounced in individuals without prior ULT. Under combined treatment, 97.7% of participants achieved a SU level below 6 mg/dL, while 79.5% achieved a level below 5 mg/dL. Rates of target achievement did not differ by sex, age, body mass index, comorbidities, type of SGLT2 inhibitor, or initial treatment sequence. We observed a trend towards a lower prescribed versus predicted allopurinol dose and a significant reduction in diuretic use (60.9% vs. 47.8%, p < 0.001) after initiation of combined treatment. Combining SGLT2 inhibitors and ULT (mainly allopurinol) in people with gout achieved significant SU reductions and helped achieve treatment goals. These results, alongside lower diuretic use and possibly lower allopurinol dose requirements, point towards an interesting management approach for gout.