Tirzepatide lowered uric acid in SURMOUNT-1 analysis, mostly through weight loss
A large trial analysis shows tirzepatide lowers uric acid over time, while case reports describe gout flares early in treatment.
Tirzepatide (sold as Mounjaro and Zepbound) lowered serum uric acid over 72 weeks in a post hoc analysis of the SURMOUNT-1 trial, with most of the decline tied to weight loss, according to results published in Annals of the Rheumatic Diseases [1]. Separate case reports describe the opposite pattern early in treatment: short-term increases in uric acid and gout attacks in the first months of therapy with tirzepatide and semaglutide, which is sold as Ozempic, Wegovy and Rybelsus [2].
In the SURMOUNT-1 analysis, serum uric acid fell by 0.69 to 0.95 mg/dL depending on tirzepatide dose after 72 weeks, compared with a decline of 0.18 mg/dL in the placebo group [1]. The reduction appeared regardless of participants' uric acid level or BMI at the start of the trial [1]. A mediation analysis attributed 72.7 percent of the drop to weight loss, leaving the remaining portion not explained by weight change alone [1].
The case reports, published in AACE Endocrinology and Diabetes, describe transient rises in serum uric acid and gout attacks after the weight-loss effect of tirzepatide and semaglutide [2]. Case reports describe individual patients rather than tracking a defined group, so they cannot show how often these early events occur or which patients are more likely to have them [2]. The two publications are also different kinds of evidence: one is a post hoc analysis of a randomized, placebo-controlled trial, meaning the uric acid question was examined after the trial was designed, and the other is a set of individual case descriptions [1][2].
Neither analysis reported whether people taking either drug had fewer gout attacks or fewer uric-acid-related problems over time. Whether the average decline seen at 72 weeks in SURMOUNT-1 translates into less gout or fewer flares has not been reported [1]. It also has not been reported whether the early increases described in the case reports are a response to rapid weight loss, to the drugs themselves, or to something else [2].
Why it matters for patients
Serum uric acid is the lab value doctors follow when assessing gout risk, and it is a common concern for people who have had gout or kidney stones. For that group, the SURMOUNT-1 analysis suggests the average trend over more than a year points down, and that the size of the drop varies with the tirzepatide dose [1].
The case reports point to a different experience for some patients in the first months, when uric acid may rise and gout attacks may occur before any longer-term decline [2]. How common that early pattern is, and whether it is more likely in people with a history of gout, has not been reported [2].
One practical consequence is that a single uric acid reading taken shortly after starting treatment may not reflect where the level settles later. The published reports do not say whether monitoring uric acid during the first months of treatment changes outcomes, and they do not address whether any change in gout treatment is warranted [1][2].
What happens next
The SURMOUNT-1 post hoc analysis and the case report series have both been published [1][2]. A study designed specifically to measure whether tirzepatide or semaglutide reduce gout attacks, rather than uric acid levels alone, has not been reported in either publication [1][2]. Whether a trial with gout flares as a planned outcome is underway has not been disclosed.
Sources
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