Uric Acid Lowering Effect of Sodium-Glucose Cotransporter 2 Inhibitors

• Published in: Gout and Uric & Nucleic Acids Vol. 44; no. 1; pp. 61 - 74
• Main Authors: Kuriyama, Satoru, Nakano, Tomoko, Tanabe, Tomoko, Makita, Mayumi, Miyakawa, Yoshinari, Komita, Hideo, Hirao, Maki, Osada, Makoto, Miho, Otoya
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Gout and Uric & Nucleic Acids 25.07.2020
• Subjects: Blood pressure; HbA1c; Serum uric acid; SGLT2 inhibitors; Urinary albumin excretion
• DOI: 10.14867/gnamtsunyo.44.1_61

Background: Evidence has emerged that SGLT2 inhibitors provide cardiorenal protective effects in type 2 diabetics. The mechanisms are multifactorial, but uric-acid (UA) lowering effect may be involved at least in part.Subjects & Methods: The present study focused on changes in clinical parameters including serum UA concentration in 90 type-2 diabetics treated with SGLT2 inhibitors for a long period of time.Results: SGLT2 inhibitors improve diabetes-related parameters such as postprandial plasma glucose concentration, HbA1c, 1,5-AG, blood pressure, body weight, BMI, and triglyceride. Furthermore, lowering of serum UA level started at 4 weeks of treatment with SGLT2 inhibitors and the effects remained constant for a period of over 48 weeks. Decrease in serum UA level was positively correlated with the increased glycosuria, which was associated with an increase in fractional excretion of urinary UA (FEUA). Urinary albumin-creatinine ratio (ACR) was normalized in a considerable number of patients, suggesting a reno-protective effect of SGLT2 inhibitors. Comparisons of individual parameters among groups given 6 different SGLT2 inhibitors showed no specific differences, suggesting that the pharmacological effects elicited by these drugs were regarded as so-called “the Class Effect”. The benefit of SGLT2 inhibitors on the prevention of gout is yet unknown.Conclusion: SGLT2 inhibitors exert long-term serum UA lowering effect in association with increased urinary glucose and UA excretion. Whether this effect is beneficial in diabetics with hyperuricemia is still a matter for debate.