BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) offer cardiorenal benefits in patients with type 2 diabetes mellitus (T2DM).
OBJECTIVE: To evaluate safety and effectiveness of SGLT2i in improving clinical outcomes in patients with psoriasis and comorbid T2DM, compared with dipeptidyl peptidase-4 inhibitors (DPP4i) and glucagon-like peptide-1 receptor agonists (GLP1RA).
METHODS: This emulated target trial included adults with psoriasis and T2DM initiating SGLT2i, DPP4i, or GLP1RA between 2013 and 2025. SGLT2i initiators were propensity score-matched to DPP4i initiators and GLP1RA initiators, respectively. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI) of the outcomes.
RESULTS: Compared with DPP4i, treatment with SGLT2i was associated with significantly lower all-cause mortality (HR=0.633, 95% CI=0.564-0.711) and reduced risks of emergency visits (HR=0.915, 95% CI=0.871-0.961), acute kidney injury (HR=0.834, 95%CI=0.759-0.916), chronic kidney disease (HR=0.866, CI=0.791-0.949), end-stage renal disease (HR=0.555, 95%CI=0.438-0.703), and severe sepsis (HR=0.689, CI=0.594-0.799). Compared with GLP1RA, treatment with SGLT2i was associated with reduced risks of asthma (HR=0.822, 95% CI=0.713-0.946), depression (HR=0.887, CI=0.801-0.983), sleep disorders (HR=0.856, CI=0.783-0.936), and malignancies (HR=0.852, 95% CI=0.764-0.951).
LIMITATIONS: Retrospective design.
CONCLUSION: Treatment with SGLT2i was associated with improved clinical outcomes in patients with psoriasis and comorbid T2DM. These findings support investigation of SGLT2i as an adjunct therapy in this population.
