Association of glucagon‐like peptide‐1 receptor agonist use with clinical outcomes in patients with rheumatoid arthritis and type 2 diabetes

ABSTRACT 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.