Autoimmune Disease Risk With GLP-1RA, DPP-4i, and SGLT2i Treatment in Patients With Diabetes.

Cohort studyACR open rheumatology· Jul 2026

Autoimmune Disease Risk With GLP-1RA, DPP-4i, and SGLT2i Treatment in Patients With Diabetes.

Arjun Mahajan, David W Bates, Alessandro Doria … Jeffrey A Sparks

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RheumatologyCohort studyTreatmentQ1IF 2.5

DPP-4i therapy linked to over twofold higher risk of dermatomyositis than GLP-1RA

Autoimmune Disease Risk With GLP-1RA, DPP-4i, and SGLT2i Treatment in Patients With Diabetes.

Arjun Mahajan … Jeffrey A Sparks

ACR open rheumatology · Jul 2026

Purpose

Dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) are widely used for type 2 diabetes, yet their comparative immunologic safety is uncertain.

Methods

We conducted emulated target trials using electronic health record data from 152 health care organizations in the TriNetX network (2016-2023).

Results

DPP-4i more than doubles dermatomyositis risk versus GLP-1RA

HR by subgroup · 95% CI

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Conclusion · 1 of 2

Compared with GLP-1RA, DPP-4i use decreased psoriasis and thyroiditis risk but increased dermatomyositis, bullous pemphigoid, and giant cell arteritis risk. No significant differences were observed between GLP-1RA and SGLT2i treatments.

Conclusion · 2 of 2

These findings provide novel safety signals and may inform antidiabetic drug selection while guiding future mechanistic and prospective research.

Autoimmune Disease Risk With GLP-1RA, DPP-4i, and SGLT2i Treatment in Patients With Diabetes.

Autoimmune Disease Risk With GLP-1RA, DPP-4i, and SGLT2i Treatment in Patients With Diabetes.

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