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06.05.2024 | Original Research

Empagliflozin and Risk of Incident Gout: Analysis from the EMPagliflozin Comparative Effectiveness and SafEty (EMPRISE) Cohort Study

verfasst von: Helen Tesfaye, PharmD, MSc, Katherine M. Wang, MD, MS, Luke E. Zabotka, BA, Deborah J. Wexler, MD, MSc, Niklas Schmedt, DrPH, Lisette Koeneman, MD, Leo Seman, MD, PhD, Julie M. Paik, MD, ScD, MPH, Elisabetta Patorno, MD, DrPH

Erschienen in: Journal of General Internal Medicine

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Abstract

Background

Hyperuricemia is frequently observed in patients with type 2 diabetes (T2D) and is associated with increased risk of gout and cardiovascular disease (CVD). Empagliflozin lowers serum urate levels by enhancing its urinary excretion.

Objective

To compare initiators of empagliflozin vs dipeptidyl peptidase-4 inhibitor (DPP4i) and initiators of empagliflozin vs glucagon-like peptide-1 receptor agonist (GLP-1RA) with respect to the risk of incident gout events.

Design and Participants

Using three claims-based datasets from 08/2014 to 09/2019, we generated two cohorts (cohort 1: empagliflozin vs DPP4i; cohort 2: empagliflozin vs GLP-1RA) of adult patients with T2D and without prior history of gout or gout-specific medication dispensing separately in each dataset. To assess the risk of incident gout, we estimated hazard ratios (HR) and rate differences (RD) per 1000 person-years (PY) with their 95% confidence intervals (CI) before and after 1:1 propensity score (PS) matching adjusting for 141 baseline covariates.

Key Results

We identified 102,262 pairs of 1:1 propensity score-matched adults in cohort 1 and 131,216 pairs in cohort 2. Over a mean follow-up period of 8 months on treatment, the risk of gout was lower in patients initiating empagliflozin compared to DPP4i (HR = 0.69: 95% CI (0.60–0.79); RD = − 2.27: 95% CI (− 3.08, 1.46)) or GLP-1RA (HR = 0.83: 95% CI (0.73–0.94); RD = − 0.99: 95% CI (− 1.66, − 0.32)). Results were consistent across subgroups (sex, age, body mass index, chronic kidney disease, heart failure, cardiovascular disease, and concurrent diuretic use) and sensitivity analyses.

Conclusions

Among adults with T2D, the initiation of empagliflozin vs a DPP4i or GLP-1RA was associated with lower risk of incident gout, complementing results from a post hoc analysis of the EMPA-REG OUTCOME trial and previously published observational research focusing on the sodium-glucose co-transporter-2 inhibitor class in more narrowly defined study populations.

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Titel: Empagliflozin and Risk of Incident Gout: Analysis from the EMPagliflozin Comparative Effectiveness and SafEty (EMPRISE) Cohort Study
verfasst von: Helen Tesfaye, PharmD, MSc
Katherine M. Wang, MD, MS
Luke E. Zabotka, BA
Deborah J. Wexler, MD, MSc
Niklas Schmedt, DrPH
Lisette Koeneman, MD
Leo Seman, MD, PhD
Julie M. Paik, MD, ScD, MPH
Elisabetta Patorno, MD, DrPH
Publikationsdatum: 06.05.2024
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-024-08793-9

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Empagliflozin and Risk of Incident Gout: Analysis from the EMPagliflozin Comparative Effectiveness and SafEty (EMPRISE) Cohort Study

Abstract

Background

Objective

Design and Participants

Key Results

Conclusions

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Live-Webinar "Urologie und Sexualmedizin in der Praxis"

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Abstract

Background

Objective

Design and Participants

Key Results

Conclusions

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Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Costims – das nächste heiße Ding in der Krebstherapie?

Perioperative Checkpointhemmer-Therapie verbessert NSCLC-Prognose

Positiver FIT: Die Ursache liegt nicht immer im Dickdarm

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

Update Innere Medizin