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. 2025 Jul;44(7):2971-2979.
doi: 10.1007/s10067-025-07502-z. Epub 2025 Jun 3.

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

Hung-Kai Shih  1 , Yu-Te Su  1 , Sy-Jou Chen  1 , Chen-Chih Chu  2 , Yu-Ching Chou  3 , Tsung-Kun Lin  4   5 , Ching-Kuo Huang  6 , Wen-Tung Wu #  7   8 , Ming-Hsun Lin #  9
Affiliations

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

Hung-Kai Shih et al. Clin Rheumatol. 2025 Jul.

Abstract

Introduction: 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.

Method: 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.

Results: 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.

Conclusions: 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.

Keywords: Gout; Lansoprazole; National Health Insurance Research Database (NHIRD); Proton pump inhibitor (PPI).

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Conflict of interest statement

Compliance with ethical standards. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Tri-Service General Hospital (TSGHIRB No.: A202405037). As the data used were de-identified and released for research purposes, informed consent from the participants was waived. Consent for publication: Not applicable. Disclosures: None.

Figures

Fig. 1
Fig. 1
Flow chart of the study design
Fig. 2
Fig. 2
Kaplan–Meier curves for the cumulative incident of gout stratified by administration of lansoprazole or other PPIs
See this image and copyright information in PMC

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