Lansoprazole associated with a relatively lower gout risk among PPI users: a nationwide retrospective study

Proton pump inhibitors (PPIs) used for gastrointestinal-related disorders are associated with increased insulin resistance, a risk factor for worsening hyperuricemia. However, lansoprazole has shown potential in reducing insulin resistance by increasing the expression of peroxisome proliferator-activated receptor gamma and CCAAT/enhancer-binding protein alpha mRNA in adipogenesis. This study aims to investigate the effects of lansoprazole compared to other PPIs in reducing the risk of gout.

We conducted a retrospective cohort study on patients using lansoprazole from 2000 to 2005, based on the Taiwan National Health Insurance Database, with follow-up until 2013. A comparison cohort on other PPIs was selected through propensity score matching for age, sex, comorbidities, and concomitant medications. Gout risk was analyzed using survival analysis and a Cox proportional hazards model.

Among 1816 lansoprazole users, 139 developed gout (7.7%), compared to 968 (13.3%) out of 7264 in the other PPIs group. The average age was 53.33 (± 14.79) in the lansoprazole group and 52.71 (± 14.81) in the other PPIs group. The cumulative incidence of gout was lower in the lansoprazole cohort, with a significantly reduced gout risk (adjusted hazard ratio, 0.64; 95% CI, 0.56-0.73). This lower risk remained after stratification by gender and among individuals over 30 years old.

Among PPI users, lansoprazole is associated with a significantly lower risk of gout. For patients at risk of gout who require PPI therapy, lansoprazole may be considered the treatment of choice.