Prospects for the use of new antidiabetic drugs in rheumatology

In the spectrum of comorbid pathology in rheumatic and musculoskeletal diseases (RMD), metabolic disorders attract special attention, primarily obesity, associated with an increased risk of developing autoimmune diseases, including RMD, in the population. In rheumatology, the problem of using antidiabetic drugs that reduce the risk of obesity is considered not only from the point of view of treating type 2 diabetes mellitus (T2DM), but also as a broader problem associated with the prospects of repositioning, defined as a strategy for finding new medical indications for existing, approved for use or studied drugs, which is especially important for the harmonization of therapy for complex RMD. In recent years, new classes of drugs have been developed for the treatment of T2DM and its complications: glucagon-like peptide 1 receptor agonists (GLP1-RAs), and sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors; gliflozins). Along with the classical antidiabetic effects, GLP-1RAs and SGLT-2 inhibitors have a wide range of anti-inflammatory and immunomodulatory mechanisms of action, which can potentiate the effectiveness of anti-inflammatory therapy for RMD and inhibit the development of comorbid pathology. The article discusses data regarding the mechanisms of anti-inflammatory activity of antidiabetic drugs and their effectiveness in RMD. However, in order to determine the true place of these drugs in relation to the personalization of RMD therapy, primarily in reducing the risk of various comorbid pathologies, further studies are needed aimed at directly comparing the effectiveness of drugs in various clinical scenarios.