Abatacept conferred a greater reduction in cardiovascular risk compared with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) and diabetes mellitus (DM), according to findings published in the Journal of the American Heart Association.
Using claims data from MarketScan and Medicare, investigators enrolled a total of 13,039 propensity-score (PS)-matched patients with RA who were started on abatacept or TNF. In the patients from MarketScan who had DM, a total of 2742 were 1:1 (PS)-matched to abatacept and TNF inhibitors and 11,130 patients in the non-DM MarketScan group were matched to either therapy.
Also, 4238 individuals with DM in the Medicare group were 1:1 PS-matched to abatacept or TNF inhibitors and 7968 non-DM individuals in this group were also matched to each therapy.
The risk for a composite of myocardial infarction, stroke/transient ischemic attack, and coronary revascularization comprised the primary outcome.
In the overall cohort, the risk for the primary outcome as related to abatacept compared with TNF inhibitor use was lower in the Medicare group (hazard ratio [HR], 0.81; 95% CI, 0.66-0.99) vs MarketScan (HR, 0.95; 95% CI, 0.74-1.23). The pooled HR for the primary outcome in both groups was 0.86 (95% CI, 0.73-1.01; P =.3 for heterogeneity).
In addition, abatacept was associated with a nonsignificantly lower risk for the primary outcome compared with TNF inhibitors in the DM subgroup (pooled HR, 0.74; 95% CI, 0.57-0.96; P =.7 for heterogeneity), whereas no risk reduction was associated with patients who did not have DM (pooled HR, 0.94; 95% CI, 0.77-1.14; P =.4 for heterogeneity).
The investigators suggested their findings are limited in that they were unable to obtain information on patients’ RA activity and duration, level of physical activity, family history, or dietary patterns. Also, the somewhat small size of each subgroup may not have been large enough to provide adequate statistical power for the sensitivity or subgroup analyses.
According to the investigators, the ability of abatacept to restore lipid profile and to improve insulin sensitivity in patients with RA “may explain our findings of reduced risks [for] CVD in patients with RA with underlying DM.”
Kang EH, Jin Y, Brill G, et al. Comparative cardiovascular risk of abatacept and tumor necrosis factor inhibitors in patients with rheumatoid arthritis with and without diabetes mellitus: a multidatabase cohort study [published online January 24, 2018]. J Am Heart Assoc. doi:10.1161/JAHA.117.007393