Gout is the most common inflammatory arthritis with a substantial and rising global disease burden [1]. This ‘modern gout epidemic,’ combined with suboptimal gout care, has resulted in high rates of recurrent gout flares, a recent rise in opioid use in gout patients, and increasing emergency department (ED) visits and hospitalizations due to gout over the past several decades [1]. Many individuals with gout have high cardiovascular risk at baseline due to the strong association between gout and cardiovascular-kidney-metabolic comorbidities, including type 2 diabetes, metabolic syndrome, chronic kidney disease (CKD), and cardiovascular disease [1]. Now, there is evidence that each gout flare episode may also be associated with a transiently increased risk of adverse cardiovascular events [2]. Thus, interventions that can simultaneously address both gout morbidity and cardiovascular-kidney-metabolic risk would be ideal in gout care [1].

To this end, sodium-glucose cotransporter type 2 inhibitors (SGLT2i) have demonstrated multiple cardiovascular-kidney-metabolic benefits among patients with and without type 2 diabetes [3] that are highly relevant to patients with gout. Furthermore, randomized controlled trials in individuals with and without type 2 diabetes have found that SGLT2i also reduce serum urate concentrations [4], the key causal mediator of gout flares, by up to 1.8 mg/dL among those with hyperuricemia [5]. However, no data are available specifically among patients with gout, particularly those on concurrent first-line urate-lowering therapy (ULT) as recommended by the American College of Rheumatology (ACR) [6] and European League Against Rheumatism (EULAR) [7] gout management guidelines. Furthermore, these randomized controlled trials examined the effect of SGLT2i compared to placebo for SU outcomes. While recent studies of SGLT2i [8,9] have found lower gout risk compared with other second-line antihyperglycemic agents, no study has examined the outcome of SU change specifically among patients with gout. To address this evidence gap, we determined the SU change among patients with gout treated with SGLT2i compared with sulfonylurea, the second-most widely used antihyperglycemic medication after metformin [10].