Why is this important?
Sodium-glucose cotransporter SGLT2 (iSGLT2) inhibitors are indicated in patients with chronic heart failure. These drugs reduce uric acid levels and may reduce the incidence of gout, which is a common comorbidity of heart failure. It was therefore interesting to compile data from clinical studies in order to better appreciate to what extent dapagliflozin can influence the use of anti-gout treatments.
Methodology
DAPA-HF and DELIVER are two clinical studies involving patients with symptomatic heart failure and elevated levels of natriuretic peptide. They were randomized, double-blind, between a group treated with dapagliflozin 10mg and another with placebo.
A history of gout was recorded and patients who were not treated with a urate lowering agent or colchicine at inclusion were included in the analysis aimed at identifying those who initiated this type of treatment.
Principle results
The two studies gathered a total of 11,005 patients of whom 10.1% had a history of gout at inclusion, the figure being broadly comparable in those who had or did not have a left ventricular ejection fraction (LVEF)≤40%. . Regardless of LVEF value, those with gout had a significantly higher cardiovascular risk, with no significantly higher all-cause cardiovascular mortality or hospitalizations for HF.
Dapagliflozin reduced the risk of cardiovascular death equally in those with and without gout (HR 0.79 [0,71-0,87]).
During follow-up, 1.0% of those who were not initially treated with colchicine initiated this treatment, ie 3.9 per 1000 person-years in the dapagliflozin group versus 7.2 in the placebo group. Thus, the use of dapagliflozin was associated with a reduction in the use of colchicine compared to placebo (HR 0.54 [0,37-0,80]), with no difference between those with or without a history of gout.