2657: Incidence of Rheumatic Diseases Among Patients Receiving GLP-1 Receptor Agonists: A Comparative Analysis with DPP-4 Inhibitors in a Propensity Score-Matched Cohort

Background/Purpose: GLP-1 receptor agonists (GLP-1RAs) are increasingly utilized in diabetes mellitus management due to their glucose-lowering and cardiovascular benefits. However, the effect of GLP-1RAs on rheumatic disease incidence is not well defined. This study evaluates the incidence of rheumatic diseases in patients treated with GLP-1RAs, using patients receiving DPP-4 inhibitors (DPP-4i) as a comparator group.

Methods: We conducted a propensity score-matched cohort study utilizing the TriNetX Analytics Network database, comprising anonymized patient data from healthcare institutions worldwide. Adult patients (≥18 years) initiating treatment with GLP-1RAs were matched 1:1 with those initiating DPP-4i therapy based on age, sex, race, hemoglobin A1c levels, BMI, underlying comorbidities, commonly used medications, and diabetes medications to ensure baseline comparability. The primary outcomes included the incidence rates of rheumatoid arthritis, gout, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, psoriatic arthritis, and osteoarthritis within 1 year after the index date. Cox proportional hazards models were employed to assess and compare the risk (hazard ratios [HRs]) of developing various rheumatic diseases between the groups. Statistical significance was set at a p-value < 0.05.

Results: After matching, each group comprised 217,302 patients. Mean age (59.5±12.5 vs. 59.6±13.3 years), sex (50.9% vs. 51.2% males), mean hemoglobin A1c (8.4 ± 2.0 vs. 8.4 ± 2.1), and BMI (33.5 ± 7.6 vs. 32.7 ± 7.3) were similar between groups. Additionally, the GLP-1RA group showed significantly reduced risks of rheumatoid arthritis (HR 0.87; 95% CI 0.77–0.98; p=0.026), gout (HR 0.82; 95% CI 0.77–0.88; p< 0.001), and osteoarthritis (HR 0.92; 95% CI 0.89–0.94; p< 0.001). No significant differences were noted for systemic lupus erythematosus, ankylosing spondylitis, scleroderma, or psoriatic arthritis.

Conclusion: In this propensity score-matched study, GLP-1RA therapy was associated with a significantly reduced incidence of rheumatoid arthritis, gout, osteoarthritis, compared to DPP-4i treatment. These findings suggest beneficial effects of GLP-1RAs on rheumatological outcomes, supporting their broader therapeutic implications in diabetes management.