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Observational Study
. 2018 Jan 24;7(3):e007393.
doi: 10.1161/JAHA.117.007393.

Comparative Cardiovascular Risk of Abatacept and Tumor Necrosis Factor Inhibitors in Patients With Rheumatoid Arthritis With and Without Diabetes Mellitus: A Multidatabase Cohort Study

Eun Ha Kang  1   2 , Yinzhu Jin  1 , Gregory Brill  1 , Jennifer Lewey  1   3 , Elisabetta Patorno  1 , Rishi J Desai  1 , Seoyoung C Kim  4   5
Affiliations
Observational Study

Comparative Cardiovascular Risk of Abatacept and Tumor Necrosis Factor Inhibitors in Patients With Rheumatoid Arthritis With and Without Diabetes Mellitus: A Multidatabase Cohort Study

Eun Ha Kang et al. J Am Heart Assoc. .

Abstract

Background: We examined the cardiovascular risk of abatacept compared with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis with and without diabetes mellitus (DM).

Methods and results: We conducted a cohort study of patients with rheumatoid arthritis who newly started abatacept or TNF inhibitors using claims data from Medicare and MarketScan. The primary outcome was a composite cardiovascular end point of myocardial infarction (MI), stroke/transient ischemic attack, and coronary revascularization. To account for >60 baseline characteristics, abatacept initiators were 1:1 propensity score (PS) matched to TNF initiators in each database. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) in the PS-matched cohort per database. A fixed-effects meta-analysis pooled database-specific HRs. We included a total of 13 039 PS-matched pairs of abatacept and TNF inhibitor initiators (6103 pairs in Medicare and 6936 pairs in MarketScan). A total of 34.7% in Medicare and 19.8% in MarketScan had baseline DM. The HR (95% CI) for the primary outcome associated with abatacept use versus TNF inhibitor was 0.81 (0.66-0.99) in Medicare and 0.95 (0.74-1.23) in MarketScan, with a pooled HR of 0.86 (95% CI, 0.73-1.01; P=0.3 for heterogeneity). The risk of the primary outcome was lower in abatacept initiators versus TNF inhibitors in the DM subgroup, with a pooled HR of 0.74 (95% CI, 0.57-0.96; P=0.7 for heterogeneity), but not in the non-DM subgroup, with a pooled HR of 0.94 (95% CI, 0.77-1.14; P=0.4 for heterogeneity).

Conclusions: In this large population-based cohort of patients with rheumatoid arthritis, abatacept use appeared to be associated with a modestly reduced cardiovascular risk when compared with TNF inhibitor use, particularly in patients with DM.

Keywords: cardiovascular disease; comparative effectiveness research; diabetes mellitus; rheumatoid arthritis; treatment.

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Figures

Figure 1
Figure 1
Study cohort selection process. In each of the 2 databases, the propensity score (PS) matching was done in the diabetes mellitus (DM) and non‐DM subgroups separately first, and the 2 subgroups were merged to create the main PS‐matched cohort. RA indicates rheumatoid arthritis; and TNF, tumor necrosis factor.
Figure 2
Figure 2
Composite cardiovascular disease (CVD) event‐free survival curve in the main propensity score–matched cohort of the 2 data sources (Medicare [A] and MarketScan [B]). TNF indicates tumor necrosis factor.
Figure 3
Figure 3
Comparative risk of secondary cardiovascular outcomes between abatacept vs tumor necrosis factor (TNF) inhibitor initiators. A, The main propensity score (PS)–matched cohort, which combines subgroups with diabetes mellitus (DM; B) and without DM (C). CI indicates confidence interval; HR, hazard ratio; and TIA, transient ischemic attack.
See this image and copyright information in PMC

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