痛風と2型糖尿病患者におけるナトリウム-グルコース共輸送体2阻害薬開始後の痛風関連薬剤使用：集団ベースのターゲットトライアルエミュレーション研究
Natalie McCormick1,2,3,4, Nitzan Burrack5, Chio Yokose1,2,3
1Rheumatology and Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA.
Diabetes care
|January 30, 2026
まとめ
ナトリウム-グルコース共輸送体2阻害薬（SGLT2i）は、2型糖尿病患者の痛風治療薬の必要性を低下させる可能性があります。この所見は、SGLT2iが一般的な痛風治療薬の副作用への曝露を減らす可能性を示唆しています。
科学分野:
- 心血管および代謝科学;腎臓病学;リウマチ学
背景:
- ナトリウム-グルコース共輸送体2阻害薬（SGLT2i）は、血清尿酸値を低下させることが知られている。; SGLT2iは、痛風再発のリスク低下と関連している。; 痛風患者は、2型糖尿病や多剤併用などの併存疾患を持つことが多い。
研究 の 目的:
- SGLT2阻害薬と他の糖尿病薬の間で、痛風管理のための薬剤開始と使用を比較すること。; SGLT2i使用者とジペプチジルペプチダーゼ4阻害薬（DPP-4i）またはグルカゴン様ペプチド1受容体作動薬（GLP-1RA）使用者におけるアロプリノール、抗炎症薬（グルココルチコイド、NSAIDs、コルヒチン）、および利尿薬の使用を評価すること。
主な方法:
- 一般人口データベースを用いてターゲットトライアルエミュレーションを使用した。; 逆確率重み付けを用いたCox比例ハザードモデルおよびポアソン回帰を適用した。; 血清尿酸値とBMIを調整して、電子カルテデータセットで解析を複製した。
主要な成果:
- SGLT2i開始群は、DPP-4i使用者と比較して、アロプリノール開始率が低かった（HR 0.62）。; SGLT2iは、高用量グルココルチコイド（RR 0.78）、NSAIDs（RR 0.85）、コルヒチン（RR 0.87）、および利尿薬（RR 0.87）の使用減少と関連していた。; これらの関連は、ベースラインで利尿薬を使用している患者でより顕著であり、二次解析でも持続した。
結論:
- SGLT2阻害薬は、痛風と2型糖尿病患者における痛風関連薬剤の必要性を低下させる可能性がある。; 薬剤使用の減少は、このハイリスク集団におけるNSAIDsおよびグルココルチコイドに関連するリスクを軽減する可能性がある。; 痛風患者におけるSGLT2iの心血管・腎臓・代謝上の利点に関するさらなる研究が求められる。
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