April Jorge,Aakash V Patel,Baijun Zhou,Lingxiao Zhang,Hyon Choi
{"title":"胰高血糖素样肽-1受体激动剂的使用和系统性红斑狼疮和狼疮肾炎患者心脏和肾脏不良结局的风险","authors":"April Jorge,Aakash V Patel,Baijun Zhou,Lingxiao Zhang,Hyon Choi","doi":"10.1002/art.43403","DOIUrl":null,"url":null,"abstract":"OBJECTIVE\r\nGlucagon-like peptide-1 receptor agonists (GLP-1RA) have cardioprotective and kidney-protective benefits among patients with type 2 diabetes (T2D). We sought to determine whether GLP-1RA use improves cardiovascular (CV) and kidney outcomes among patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN).\r\n\r\nMETHODS\r\nWe emulated a pragmatic target trial to evaluate the impact of GLP-1RA vs. comparator hypoglycemic agents, dipeptidyl peptidase 4 inhibitors (DPP4i), on CV and kidney outcomes among patients with SLE and T2D using a large, US multi-center electronic health record database. We used propensity score overlap weighting to emulate randomization between treatment groups. Outcomes included major adverse cardiovascular events, venous thrombosis (VTE), kidney disease progression (eGFR decline ≥ 30% or new-onset end-stage kidney disease), and all-cause mortality. We used Cox regression to compare hazard ratios (HR) based on the weighted populations. In a secondary analysis, we only included patients with LN.\r\n\r\nRESULTS\r\nThere were 910 and 1004 initiators of GLP-1RA and DPP4i, respectively, including 267 and 324 patients with LN, respectively. Baseline covariates were balanced after propensity score overlap weighting. The risks of MACE (HR 0.66 [95% CI 0.48-0.91]), VTE (HR 0.49 [0.24-0.97]), kidney disease progression (HR 0.77 [0.60-0.98]), and all-cause mortality (HR 0.26 [CI 0.10-0.68]) were lower with GLP-1RA vs. DPP4i use. GLP-1RA use was similarly associated with lower risks of MACE and kidney disease progression among patients with LN.\r\n\r\nCONCLUSION\r\nWe found lower risks of adverse CV and kidney outcomes and mortality with GLP-1RA use compared with DPP4i use among patients with lupus and T2D.","PeriodicalId":129,"journal":{"name":"Arthritis & Rheumatology","volume":"86 1","pages":""},"PeriodicalIF":10.9000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"April Jorge,Aakash V Patel,Baijun Zhou,Lingxiao Zhang,Hyon Choi\",\"doi\":\"10.1002/art.43403\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVE\\r\\nGlucagon-like peptide-1 receptor agonists (GLP-1RA) have cardioprotective and kidney-protective benefits among patients with type 2 diabetes (T2D). We sought to determine whether GLP-1RA use improves cardiovascular (CV) and kidney outcomes among patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN).\\r\\n\\r\\nMETHODS\\r\\nWe emulated a pragmatic target trial to evaluate the impact of GLP-1RA vs. comparator hypoglycemic agents, dipeptidyl peptidase 4 inhibitors (DPP4i), on CV and kidney outcomes among patients with SLE and T2D using a large, US multi-center electronic health record database. We used propensity score overlap weighting to emulate randomization between treatment groups. Outcomes included major adverse cardiovascular events, venous thrombosis (VTE), kidney disease progression (eGFR decline ≥ 30% or new-onset end-stage kidney disease), and all-cause mortality. We used Cox regression to compare hazard ratios (HR) based on the weighted populations. In a secondary analysis, we only included patients with LN.\\r\\n\\r\\nRESULTS\\r\\nThere were 910 and 1004 initiators of GLP-1RA and DPP4i, respectively, including 267 and 324 patients with LN, respectively. Baseline covariates were balanced after propensity score overlap weighting. The risks of MACE (HR 0.66 [95% CI 0.48-0.91]), VTE (HR 0.49 [0.24-0.97]), kidney disease progression (HR 0.77 [0.60-0.98]), and all-cause mortality (HR 0.26 [CI 0.10-0.68]) were lower with GLP-1RA vs. DPP4i use. GLP-1RA use was similarly associated with lower risks of MACE and kidney disease progression among patients with LN.\\r\\n\\r\\nCONCLUSION\\r\\nWe found lower risks of adverse CV and kidney outcomes and mortality with GLP-1RA use compared with DPP4i use among patients with lupus and T2D.\",\"PeriodicalId\":129,\"journal\":{\"name\":\"Arthritis & Rheumatology\",\"volume\":\"86 1\",\"pages\":\"\"},\"PeriodicalIF\":10.9000,\"publicationDate\":\"2025-09-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthritis & Rheumatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/art.43403\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthritis & Rheumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/art.43403","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
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.
OBJECTIVE
Glucagon-like peptide-1 receptor agonists (GLP-1RA) have cardioprotective and kidney-protective benefits among patients with type 2 diabetes (T2D). We sought to determine whether GLP-1RA use improves cardiovascular (CV) and kidney outcomes among patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN).
METHODS
We emulated a pragmatic target trial to evaluate the impact of GLP-1RA vs. comparator hypoglycemic agents, dipeptidyl peptidase 4 inhibitors (DPP4i), on CV and kidney outcomes among patients with SLE and T2D using a large, US multi-center electronic health record database. We used propensity score overlap weighting to emulate randomization between treatment groups. Outcomes included major adverse cardiovascular events, venous thrombosis (VTE), kidney disease progression (eGFR decline ≥ 30% or new-onset end-stage kidney disease), and all-cause mortality. We used Cox regression to compare hazard ratios (HR) based on the weighted populations. In a secondary analysis, we only included patients with LN.
RESULTS
There were 910 and 1004 initiators of GLP-1RA and DPP4i, respectively, including 267 and 324 patients with LN, respectively. Baseline covariates were balanced after propensity score overlap weighting. The risks of MACE (HR 0.66 [95% CI 0.48-0.91]), VTE (HR 0.49 [0.24-0.97]), kidney disease progression (HR 0.77 [0.60-0.98]), and all-cause mortality (HR 0.26 [CI 0.10-0.68]) were lower with GLP-1RA vs. DPP4i use. GLP-1RA use was similarly associated with lower risks of MACE and kidney disease progression among patients with LN.
CONCLUSION
We found lower risks of adverse CV and kidney outcomes and mortality with GLP-1RA use compared with DPP4i use among patients with lupus and T2D.
期刊介绍:
Arthritis & Rheumatology is the official journal of the American College of Rheumatology and focuses on the natural history, pathophysiology, treatment, and outcome of rheumatic diseases. It is a peer-reviewed publication that aims to provide the highest quality basic and clinical research in this field. The journal covers a wide range of investigative areas and also includes review articles, editorials, and educational material for researchers and clinicians. Being recognized as a leading research journal in rheumatology, Arthritis & Rheumatology serves the global community of rheumatology investigators and clinicians.