Arthritis Rheumatol

GLP-1 agonists may reduce cardiorenal risk in lupus patients

September 30, 2025

For patients with systemic lupus erythematosus (SLE) and T2DM—including those with lupus nephritis (LN)—GLP-1 RA therapy may confer substantial reductions in CV events, kidney disease progression, and mortality compared with DPP4i therapy. These findings support consideration of GLP-1 RA as a preferred cardiometabolic agent in this high-risk population.

Study details: This multicenter, U.S.-based, pragmatic target trial emulated randomization using propensity score overlap weighting to compare GLP-1 RA vs. DPP4i in patients with SLE and T2DM, including a subgroup with LN. Outcomes assessed were major adverse cardiovascular events (MACE), VTE, kidney disease progression (≥30% eGFR decline or new end-stage kidney disease), and all-cause mortality.

Results: Among 910 GLP-1 RA and 1,004 DPP4i initiators (with 267 and 324 LN patients, respectively), GLP-1 RA use was associated with significantly lower risks of MACE (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.48–0.91), VTE (HR, 0.49; CI, 0.24–0.97), kidney disease progression (HR, 0.77; CI, 0.60–0.98), and all-cause mortality (HR, 0.26; CI, 0.10–0.68) compared with DPP4i. These benefits were similarly observed in the LN subgroup.

Source:

Jorge A, et al. (2025, September 25). Arthritis Rheumatol. Glucagon-Like Peptide-1 Receptor Agonist Use and the Risk of Adverse Cardiac and Kidney Outcomes Among Patients with Systemic Lupus Erythematosus and Lupus Nephritis. https://pubmed.ncbi.nlm.nih.gov/40994310/