Real-World Effects of GLP-1 Receptor Agonists and SGLT2 Inhibitors on Gout Outcomes and Metabolic Profiles

Abstract Gout is closely linked to metabolic disorders such as obesity, diabetes, and chronic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) may provide additional benefits beyond standard urate-lowering therapy (ULT). A comparative historical cohort study was conducted among adult patients with gout comparing ULT alone versus in combination with GLP-1 RAs or SGLT2i for at least 6 months. Clinical and laboratory data were analyzed over a 2-year follow-up. A total of 64 adult patients with gout with a median disease duration of 6.7 years were included. The mean age was 55.6 years (range 27–92) with a majority being male (45, 70.3%) patients. The mean number of gout flares decreased from 1.44 flares/year prior to ULT to 0.78 flares/year after therapy initiation (p < 0.001). Half of the subjects (32 patients) received either GLP-1 RA or SGLT2i agents (intervention group) while the other half were considered as controls. Both groups had similar age and sex distributions and received standard ULT with febuxostat or allopurinol. The intervention group had a lower number of flares: 0.32 per year compared to 1.22 in the control group (mean difference −0.9; 95% confidence interval −1.4 to −0.38; p < 0.001). In multivariate analysis, the antidiabetic agents were independent predictors of reduced flare frequency, after controlling for other covariates. Adjunctive treatment with SGLT2i or GLP-1 RAs was associated with fewer gout flares over 24 months in this real-world historical cohort. These findings should be interpreted cautiously and warrant confirmation in prospective controlled studies.