OBJECTIVES: To evaluate whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with improved survival and renal outcomes in patients with rheumatoid arthritis and type 2 diabetes, a population at high cardiometabolic risk.
MATERIALS AND METHODS: We conducted a retrospective cohort study using an active-comparator, new-user design within the TriNetX US Collaborative Network. Adults with rheumatoid arthritis and type 2 diabetes initiating GLP-1 RAs or dipeptidyl peptidase-4 inhibitors (DPP-4is) between 2016 and 2023 were included. The primary outcome was all-cause mortality; secondary outcomes were major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and all-cause hospitalization. Hazard ratios (HRs) were estimated using Cox regression after 1:1 propensity score matching.
RESULTS: A total of 4,607 patients per group were followed for up to 4 years. GLP-1 RA use was associated with lower all-cause mortality (HR 0.68; 95% confidence intervals (CI), 0.58-0.80), reduced MAKE (HR 0.89; 95% CI, 0.82-0.97), and fewer hospitalizations (HR 0.92; 95% CI, 0.86-0.98), compared with DPP-4is. No significant difference was observed for MACE (HR 0.96; 95% CI, 0.89-1.04). Results were consistent across prespecified subgroups and sensitivity analyses.
CONCLUSIONS: In patients with rheumatoid arthritis and type 2 diabetes, GLP-1 RA therapy was associated with 32% lower mortality, 11% fewer kidney events, and 8% fewer hospitalizations vs DPP-4is. These findings support GLP-1 RAs as a promising therapeutic option for this high-risk population.
