Cardiovascular Outcomes and Mortality Risk in Glucagon‑like Peptide‑1 Receptor Agonist and Sodium–glucose Cotransporter 2 Inhibitor Combination Therapy Versus Sodium–glucose Cotransporter 2 Inhibitor Monotherapy in Patients with Rheumatoid Arthritis and Type II Diabetes Mellitus: A Retrospective Study

Cardiovascular Outcomes and Mortality Risk in Glucagon‑like Peptide‑1 Receptor Agonist and Sodium–glucose Cotransporter 2 Inhibitor Combination Therapy Versus Sodium–glucose Cotransporter 2 Inhibitor Monotherapy in Patients with Rheumatoid Arthritis and Type II Diabetes Mellitus: A Retrospective Study

Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune arthritis associated with higher comorbidities such as type 2 diabetes mellitus (T2DM) and cardiovascular disease. Cardiovascular complications were a major cause of mortality in RA patients. Sodium–glucose cotransporter 2 inhibitor (SGLT2i) and glucagon‑like peptide‑1 receptor agonist (GLP‑1 RA) have shown cardiovascular benefits in T2DM patients. This study investigated whether adding GLP‑1 RA to SGLT2i confers additional protection compared with SGLT2i alone in patients with RA and T2DM. Methods: We performed a retrospective analysis using the TriNetX Global Collaborative Network. Patients≥18 years with both RA and T2DM receiving SGLT2i, with or without GLP‑1 RA, were included. The primary outcome was all‑cause mortality, whereas the secondary outcome was major adverse cardiovascular events (MACEs). Results: A total of 6968 patients were matched in each group. Combination therapy with GLP‑1 RA and SGLT2i was associated with significant reductions in all‑cause mortality and MACEs compared with SGLT2i therapy alone in study patients alone. Conclusions: RA patients with T2DM are prone to cardiovascular complications and higher mortality. Adding GLP‑1 RA to SGLT2i reduces risks of death and MACEs, potentially through improved glycemic control and possible immunomodulatory effects. Further studies are warranted to confirm these findings.