{
  "abstract": "Abstract Objective To evaluate the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and risk of autoimmune rheumatic diseases in adults with type 2 diabetes.Design Retrospective cohort study.Setting Nationwide healthcare database in South Korea, 2012-22.Participants 2 032 157 adults aged ≥18 years with type 2 diabetes: 552 065 initiated SGLT-2 inhibitors and 1 480 092 initiated sulfonylureas.Main outcome measures The primary outcome was autoimmune rheumatic disease, defined using a validated algorithm incorporating diagnostic codes and registration in a disease specific nationwide programme. Secondary outcomes were individual types of autoimmune rheumatic diseases, including inflammatory arthritis and connective tissue diseases. Genital infections and herpes zoster were used as positive and negative control outcomes, respectively, to evaluate residual confounding. Hazard ratios and rate differences per 100 000 person years were estimated after normalised inverse probability treatment weighting based on propensity score.Results After propensity score weighting, 1 030 088 initiators of SGLT-2 inhibitors (mean age 58.5 years; 59.9% men) and 1 002 069 initiators of sulfonylurea (mean age 58.5 years; 60.1% men) were included in the analysis. The weighted incidence rate per 100 000 person years was 51.90 and 58.41 in individuals initiating SGLT-2 inhibitors and sulfonylureas, respectively. Over a median of nine months’ follow-up, SGLT-2 inhibitors were associated with an 11% lower risk of incident autoimmune rheumatic diseases compared with sulfonylureas (hazard ratio 0.89 (95% confidence interval (CI) 0.81 to 0.98); rate difference −6.50 (95% CI −11.86 to −1.14) per 100 000 person years). Findings were overall consistent among subgroups stratified by age, sex, type of SGLT-2 inhibitor, baseline cardiovascular disease, and obesity status. The hazard ratios for the control outcomes were 2.78 (2.72 to 2.83) for genital infections and 1.03 (1.01 to 1.05) for herpes zoster.Conclusions In this large cohort of adults with type 2 diabetes, SGLT-2 inhibitors were associated with an 11% lower risk of autoimmune rheumatic diseases compared with sulfonylureas. These results suggest that SGLT-2 inhibitors may contribute to reducing the risk of autoimmune diseases. This potential benefit, however, should be carefully weighed against known adverse events and concerns about tolerability. Replication in other populations and settings, as well as studies in patients with existing autoimmune rheumatic diseases, are warranted to confirm and extend these observations.",
  "authors": [
    {
      "affiliations": [
        "School of Pharmacy, Sungkyunkwan University, Republic of Korea"
      ],
      "name": "Bin Hong"
    },
    {
      "affiliations": [
        "Department of Medical Informatics, Kangwon National University College of Medicine, Republic of Korea"
      ],
      "name": "Hyesung Lee"
    },
    {
      "affiliations": [
        "Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea"
      ],
      "name": "Kyungyeon Jung"
    },
    {
      "affiliations": [
        "Department of Digital Health, Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, Republic of Korea"
      ],
      "name": "Sang Youl Rhee"
    },
    {
      "affiliations": [
        "Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea"
      ],
      "name": "Dong Keon Yon"
    },
    {
      "affiliations": [
        "School of Pharmacy, Sungkyunkwan University, Republic of Korea",
        "Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea",
        "Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea"
      ],
      "name": "Ju-Young Shin"
    }
  ],
  "title": "Sodium-glucose cotransporter-2 inhibitors and risk of autoimmune rheumatic diseases: population based cohort study",
  "uid": "e3d81fd2-fb4a-544a-86bd-f919b808d110"
}