Background/Purpose: Systemic lupus erythematosus (SLE) is associated with a heightened risk of cardiovascular and renal complications, particularly in patients with comorbid diabetes mellitus. While both GLP-1 receptor agonists and SGLT2 inhibitors have shown cardio-renal benefits in the general diabetic population, comparative outcome data in patients with SLE remain limited.

Methods: This retrospective cohort study utilized data from the global TriNetX Collaborative Network and included adult patients (aged ≥18 years) diagnosed with both SLE and diabetes between January 1, 2015, and December 31, 2023. Patients were grouped based on exposure to either GLP-1 receptor agonists or SGLT2 inhibitors. The primary outcome was all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACE) and lupus nephritis. Propensity score matching (1:1) was used to balance baseline characteristics between groups. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were calculated for outcome comparisons after matching.

Results: After matching, 885 patients were included in each group. The mean ± SD age was 57.7 ± 12.1 years, with approximately 82% female and 39% identifying as White. Baseline characteristics were well balanced following propensity score matching. The incidence of MACE was significantly lower in the GLP-1 group (3.2%) compared to the SGLT2 group (6.0%; RR, 0.53; 95% CI, 0.337–0.827; p = 0.0045). Similarly, the incidence of lupus nephritis was significantly lower in the GLP-1 group (4.7%) compared to the SGLT2 group (9.8%; RR, 0.48; 95% CI, 0.338–0.689; p < 0.0001). All-cause mortality was slightly lower in the GLP-1 group (1.6%) versus the SGLT2 group (2.1%), but this difference did not reach statistical significance (RR, 0.74; 95% CI, 0.372–1.46; p = 0.737).

Conclusion: Among patients with systemic lupus erythematosus and diabetes, treatment with GLP-1 receptor agonists was associated with significantly lower rates of major adverse cardiovascular events (MACE) and lupus nephritis compared to SGLT2 inhibitors. While all-cause mortality was numerically lower in the GLP-1 group, the difference was not statistically significant. These findings suggest that GLP-1 receptor agonists may offer greater cardio-renal protection in this high-risk population and warrant further investigation in prospective clinical trials.

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparative-outcomes-of-glp-1-receptor-agonists-versus-sglt2-inhibitors-in-patients-with-systemic-lupus-erythematosus-and-diabetes-a-propensity-matched-retrospective-cohort-study/