Five studies covering 11,190 people with immune-mediated inflammatory diseases, mostly systemic lupus erythematosus (70.9%) and systemic sclerosis (25.4%), were pooled in a PRISMA-guided systematic review. Across the three studies reporting cardiovascular events, SGLT2 inhibitor use tracked with lower all-cause mortality and less heart failure, but no clear change in myocardial infarction. Genitourinary infections were the most commonly reported adverse effect. Data on hospitalisation, discontinuation and disease flares were sparse and inconsistent.
People with lupus and scleroderma carry a cardiovascular risk that standard scores underestimate, so a drug class that protects the heart and kidneys in diabetes, heart failure and chronic kidney disease is an obvious candidate. The pattern here, with heart failure and mortality benefits but a flat myocardial infarction signal, matches what the large general-population trials showed, which is mildly reassuring. The caveats are heavy, though. The evidence is predominantly observational, so confounding by indication is likely: people prescribed SGLT2 inhibitors often have diabetes, kidney disease or heart failure and are monitored more closely. Only five studies met inclusion criteria, the review is dominated by two diseases, and no meta-analytic pooling or randomised data are reported. The infection signal deserves attention in patients already on immunosuppressants. My assessment: confirmatory and hypothesis-generating rather than practice-changing. Patients with a rheumatic disease and a standard indication (type 2 diabetes, heart failure or CKD) have no reason to avoid these drugs, and should discuss them with their physicians. Using them purely for cardioprotection awaits prospective trials.