Patients with rheumatoid arthritis and overweight or obesity who received glucagon-like peptide 1 receptor agonists had greater improvements in disease activity, pain, weight, and cardiometabolic outcomes compared with patients not taking the agents, according to a retrospective cohort study conducted from 2018 to 2024.
The study reviewed records of 173 patients who received semaglutide or tirzepatide and 42 controls. Rheumatoid arthritis (RA) disease activity scores decreased in the treatment group while controls showed an increase. Pain scores on a 10-cm visual analog scale declined by 0.6 cm with GLP-1 RAs and rose by 1.3 cm in controls. Treated patients lost an average of 4 kg, compared with 1 kg in controls. Total cholesterol decreased by 10 mg/dL in the treatment group while increasing by 0.3 mg/dL in controls, and hemoglobin A1c levels fell by 0.3% in treated patients, with no change in controls.
Inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein, declined in the treatment group but not in controls though the between-group differences for these measures were not statistically significant. Reductions in low-density lipoprotein cholesterol and triglycerides were also observed among treated patients, although between-group differences for these measures were not statistically significant. Blood pressure changes were not significant in either group.
Disease activity summaries showed 32% of treated patients improved, 39% remained stable, and 29% worsened, compared with 17%, 37% , and 46% in controls, respectively. Rates of therapy escalation or de-escalation did not differ between groups. Nearly one-third of patients discontinued GLP-1 RA therapy, most often for gastrointestinal adverse effects or insurance-related issues.
The study reviewed medical records of patients with RA and body mass index of 27 or higher who were prescribed glucagon-like peptide 1 receptor agonists at a single academic health system. Patients were evaluated at 3-month intervals for up to 12 months. The treatment group primarily received subcutaneous semaglutide (84%), with smaller numbers on oral semaglutide (8%) or tirzepatide (8%) .
At baseline, the treatment and control groups had similar body mass index, RA activity, and disease-modifying antirheumatic drug use. Patients in the treatment group had higher rates of diabetes and hypertension, and higher hemoglobin A1c and triglyceride values. Sensitivity analyses adjusting for these factors did not alter the main results.
“Neither reduction in acute phase reactants nor reduction in pain was significantly correlated with weight loss, hinting that the effect on these outcomes may be modulated by mechanisms beyond weight loss,” said David A. Kellner, MD, David Geffen School of Medicine, University of California, Los Angeles, and colleagues.
The researchers cited limitations, including the retrospective, single-center design, modest sample size, and baseline differences between groups. Disease activity documentation often lacked composite scores, requiring categorical classification. Nearly one-third of patients discontinued treatment, which may have affected outcomes.
Full disclosures can be found in the study.
Source: ACR Open Rheumatology
