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CHICAGO — Patients with psoriatic arthritis (PsA) receiving GLP-1 receptor agonists (GLP-1s) had lower risks for death and experiencing major adverse cardiac events than patients with PsA not taking GLP-1s, new data indicated.
“GLP-1 receptor agonists may be a promising adjunct in the management of patients with inflammatory arthritis, who have comorbidities including obesity and/or type 2 diabetes mellitus,” the researchers wrote, led by Nanuka Tsibadze, MD, Jefferson Health-Einstein Healthcare Network in Philadelphia, who presented the data at the American College of Rheumatology (ACR) 2025 Annual Meeting.
In a nationwide retrospective study, the researchers identified 4104 patients with PsA taking GLP-1s and 86,432 patients with PsA not taking GLP-1s, using the TriNetX database, which collects data from 83 large healthcare organizations across multiple countries. Adults who had a PsA diagnosis, using the International Classification of Disease-10 codes, in the past 10 years were included.
The researchers used 1:1 propensity score matching to account for demographic variables, diagnoses, and medication use. They defined the index event as simultaneous documentation of PsA and GLP-1 use in patients’ charts. The GLP-1s in this study included semaglutide, liraglutide, exenatide, and lixisenatide.
In a comparison of overall risk after propensity score matching, the results showed that those receiving GLP-1s vs no GLP-1s had lower risk for:
- Ischemic heart disease (9% vs 12%; risk ratio [RR], 0.715)
- Cerebrovascular diseases (4.7% vs 7.8%; RR, 0.605)
- Acute myocardial infarction (2.3% vs 4.0%; RR, 0.578)
- Cerebral infarction (1.8% vs 2.9%; RR, 0.633)
- Heart failure (10.5% vs 15.0%; RR, 0.703)
- Death (1.4% vs 4.6%; RR, 0.307)
White patients made up the largest racial group in both subgroups (80.9% for GLP-1 users and 73.5% for nonusers).
Previous evidence has demonstrated that losing weight via surgery or behavioral modification is associated with disease improvement in patients with obesity and rheumatoid arthritis, PsA, or psoriasis, the authors noted.
Unanswered Questions
“It’s not just psoriatic arthritis; this concept is being applied to many rheumatological diseases, including lupus and rheumatoid arthritis,” said Howard H. Yang, MD, Division of Rheumatology, University of California Los Angeles, who was not part of the research. “We know these patients already have increased cardiovascular risk because of their underlying disease. A drug that can help them to not just decrease pounds and body mass index but [also] decrease vascular risk — it’s amazing.”
But there are unanswered questions, he told Medscape Medical News, and primary among them is: “Where is the benefit coming from? Is it the weight loss or from the drug itself?” That needs to be answered, he said, “because rheumatological patients have really high risk of cardiovascular problems.” If weight loss was the primary driver, he asked, would those successful at losing weight need less of the biologic treatment?
He says he sees GLP-1s as “a powerful adjunct,” but added that further study is needed about which patients would benefit most and when to start one — at the beginning, a few months in, or when the patient isn’t doing well on first-line therapy, for example. Also unclear is the long-term effects of GLP-1s, he noted.
“I think it’s very exciting, but I’m not ready to say every psoriatic arthritis patient should be on GLP-1s,” Yang said. If rheumatologists have a patient who is overweight, he said, they should consider referring to primary care for weight-loss options or consider starting patients on GLP-1s themself if they are comfortable in doing so.
Both the researchers and Yang did not have any relevant financial relationships to disclose.
Marcia Frellick is an independent, Chicago-based healthcare journalist and a regular contributor to Medscape Medical News.
