People living with rheumatoid arthritis and type 2 diabetes (T2DM) have a high cardiometabolic disease burden, which may influence long-term outcomes. A study published in the Journal of Diabetes Investigation assessed whether treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with survival and renal outcomes compared with dipeptidyl peptidase-4 inhibitors (DPP-4is) in this population.

The retrospective cohort study used an active-comparator, new-user design within the TriNetX US Collaborative Network. Adults with rheumatoid arthritis and T2DM who started GLP-1 RA therapy or DPP-4i therapy between 2016 and 2023 were included. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and all-cause hospitalization. Hazard ratios (HRs) were estimated using Cox proportional hazards models after 1:1 propensity score matching.

After matching, 4,607 individuals were included in each treatment group and followed for up to four years. Use of GLP-1 RAs was associated with lower all-cause mortality compared with DPP-4i therapy (HR 0.68; 95% confidence interval [CI] 0.58-0.80). GLP-1 RA therapy was also associated with fewer MAKE (HR 0.89; 95% CI 0.82-0.97) and fewer hospitalizations (HR 0.92; 95% CI 0.86-0.98).

Rates of MACE were comparable between treatment groups (HR 0.96; 95% CI 0.89-1.04). Findings were consistent across prespecified subgroup analyses and sensitivity analyses. In this cohort, GLP-1 RA therapy was associated with lower mortality and fewer kidney events and hospitalizations than DPP-4i therapy.