GLP-1 RA Uptake Remains Low Among Eligible Patients With PsA

More than half of patients with psoriatic arthritis (PsA) in a prospective cardio-rheumatology cohort met eligibility criteria for glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, yet treatment uptake remained low. Among patients with PsA, 56.7% were eligible, while only 15.7% of eligible patients were prescribed a GLP-1 RA.¹

The findings, presented at the American College of Rheumatology (ACR) Convergence 2026 in Orlando, Florida, also linked GLP-1 RA eligibility with greater inflammatory disease activity and cardiovascular morbidity in PsA.¹

Lihi Eder, MD, PhD, clinician-scientist at Women's College Research Institute and associate professor of medicine at the University of Toronto, led the analysis of the University of Toronto Cardio-Rheumatology Cohort. The results highlight the overlap between inflammatory disease burden and cardiometabolic risk in patients potentially eligible for GLP-1 RA treatment.¹,²

GLP-1 RA Eligibility and Uptake in Inflammatory Arthritis

Investigators analyzed data from 834 patients with PsA, rheumatoid arthritis (RA), or axial spondyloarthritis (axSpA) enrolled in the prospective cohort between 2017 and 2026. Participants were aged ≥40 years and had no established cardiovascular disease at enrollment.¹

Patients underwent standardized assessments at baseline, year 1, and year 5, including measures of inflammatory disease activity, cardiometabolic comorbidities, laboratory parameters, and cardiac imaging.

Eligibility for GLP-1 RA treatment was defined according to Health Canada criteria as a body mass index (BMI) ≥30 kg/m², BMI ≥27 kg/m² with an obesity-related comorbidity, or diabetes mellitus. Researchers used generalized estimating equations and linear mixed-effects models to evaluate eligibility and its associations with outcomes, adjusting for age, sex, and visit.¹

Overall, 47.5% of patients met eligibility criteria, with greater eligibility among patients with PsA (56.7%) than RA (odds ratio [OR] 1.84; P <.001). Eligibility increased from 46.1% at baseline to 56.2% at year 5 (P = .005).¹

Despite the high prevalence of eligibility, only 10.6% of eligible patients across the cohort had been prescribed a GLP-1 RA by 2026. Prescribing rates varied by inflammatory arthritis diagnosis:

• PsA: 15.7%
• RA: 5.5%
• axSpA: 13.2%

Among 52 patients prescribed GLP-1 RA therapy, semaglutide was the most commonly prescribed agent (86.5%). Overall, 13.5% discontinued treatment.¹

Greater PsA Activity and Cardiovascular Burden Among Eligible Patients

Among patients with PsA, GLP-1 RA eligibility was associated with higher Disease Activity in Psoriatic Arthritis (DAPSA) scores, high-sensitivity C-reactive protein (hsCRP), physician global assessment scores, pain, morning stiffness, and fatigue.¹

Investigators also identified a significant interaction between sex and GLP-1 RA eligibility for hsCRP (P = .008). The association was greater among female patients, with an estimated difference of 4.2 mg/L compared with 0.4 mg/L among male patients.¹

Cardiovascular findings showed a greater prevalence of diastolic dysfunction among GLP-1 RA-eligible patients with PsA compared with those who were not eligible (29.8% vs 17.7%; P = .02). Eligible patients also had a less favorable lipid profile and numerically higher coronary calcification.¹

These associations suggest patients meeting GLP-1 RA eligibility criteria may have a greater burden of inflammatory and cardiometabolic disease. However, eligibility was defined in part by obesity and diabetes, which are themselves associated with cardiovascular risk. The observational findings do not establish a causal relationship between GLP-1 RA eligibility and greater PsA activity or cardiac abnormalities.

Findings Highlight a Gap in Cardiometabolic Care

“More than half of our patients with psoriatic arthritis met criteria for GLP-1 receptor agonist therapy, yet use remained low,” Eder said in an ACR statement.²

The investigators noted that GLP-1 RAs are used to manage type 2 diabetes and obesity, but the current analysis evaluated eligibility and prescribing patterns rather than treatment efficacy. As a result, the findings cannot establish whether GLP-1 RA therapy improves inflammatory disease activity or cardiovascular outcomes in PsA.¹,²

The cohort also represents patients receiving care in a specialized cardio-rheumatology setting, potentially limiting generalizability to broader rheumatology populations. Eligibility under Health Canada criteria does not necessarily indicate treatment appropriateness for every patient, and the analysis does not establish the reasons for low uptake.

The ACR emphasized the importance of individualized treatment decisions incorporating cardiometabolic risk, contraindications, potential adverse effects, affordability, insurance coverage, and patient preferences. GLP-1 RAs are not substitutes for established disease-modifying antirheumatic therapies.²

The findings add to ongoing research examining the relationship between obesity, inflammatory disease activity, and cardiovascular risk in PsA, while identifying an opportunity to further evaluate barriers to appropriate cardiometabolic treatment.

References

1. Eder L, Akhtari S, Shahab S, et al. GLP-1 receptor agonist eligibility and uptake and their relation with psoriatic arthritis disease activity and cardiovascular morbidity: real-world data from a cardio-rheumatology cohort. Arthritis Rheumatol. 2026;78(suppl 9). Abstract 0361. ACR abstract. Accessed November 8, 2026.

2. American College of Rheumatology. New ACR Convergence research links inflammatory arthritis to elevated cardiovascular risk and identifies major gap in GLP-1 treatment uptake. Published November 7, 2026. Accessed November 8, 2026. ACR press release.