The aim of the present study was to determine whether i) empagliflozin will reduce the serum urate concentration by ≥0.04 mmol/L, ii) fenofibrate will reduce the serum urate concentration by ≥0.06 mmol/L, and iii) the combination of empagliflozin and fenofibrate will reduce the serum urate concentration by ≥0.10 mmol/L in hyperuricaemic people with type 2 diabetes.

The authors believed that combination empagliflozin-fenofibrate could allow a dose reduction in, and perhaps even replace, allopurinol in appropriate patients withtype 2 diabetes with a consequent reduction in the risk of allopurinol-associated adverse effects

There was a significant trend in the change in serum urate from Day 1 to Day 8 by treatment group but there was no statistically significant difference between the two monotherapies for empagliflozin and for fenofibrate;

The reduction with the combination was significantly greater than that for empagliflozin alone but not fenofibrate alone.

Regarding the kidney function, ( eGFR), between Days 1 and 8 there was much larger reduction with combination therapy (-10.2 mL/min/1.73m2;)

This significant mean reduction in eGFR of 10.2 mL/min/1.73m2 when the combination was used may have clinical implications. It was supported that treatment with fenofibrate should be withheld if the serum creatinine concentration increased by at least 30% as occurred in three of our participants (38%) on combination therapy.

The paper is well written and used appropriate methodological approach.

The findings are presented excellently

It is also well referenced.

I really wonder about the clinical significance of this study. What exactly do the authors suggest?

In my opinion the present study:
i) suggests that use of combination SGLT2i-fenofibrate therapy increases the serum creatinine concentration in (38%) of the participants by at least 30% .

ii) The study cannot be supported with the participation of only 8 patients

iii) The effect on uricaemia could allow rationalisation of treatment for
gout, however how many of the 8 patients exhibited symptoms of gout?

iv) The usual polypharmacy employed in diabetes management is an issue but increasing biochemical monitoring after initiation of combination therapy is aν other problem

v) The topic is interesting but not applicable in clinical practice.

vi) Μy last concern is 8 patients in a study with a recruitment of 23 mouths (July 2021 to June 2023)!