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Abstract
Background Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD). Recent studies suggested that treatment of RA with tumor necrosis inhibitors (TNFi) can reduce the risk of cardiovascular events. However, it is unclear how abatacept, a selective costimulation modulator, affects cardiovascular risk among RA patients compared with TNFi.
Objectives To evaluate the comparative cardiovascular safety of abatacept versus TNFi in RA patients with and without underlying CVD.
Methods We identified RA patients aged ≥18 with ≥2 RA ICD-9 codes (714.xx) separated by ≥7 days but <365 days, from two large insurance claims data across the U.S.: Medicare (2008–2013) and Truven MarketScan (2006–2015). Only new users of abatacept or TNFi (adalimumab, etanercept, certolizumab, golimumab, and infliximab) were included. The primary outcome of interest was a composite endpoint of CVD including myocardial infarction (MI), stroke/transient ischemic stroke, or coronary revascularization. Secondary outcomes were each component of the primary outcome, incident heart failure (HF), and venous thromboembolism (VTE). 1:1 propensity score (PS) matching was performed separately in each database and each subgroups (with or without baseline CVD). Then the PS-matched subgroups were aggregated to form the overall matched cohort. Cox regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of risk of each outcome. Estimates from two different databases were combined through an inverse variance-weighted fixed-effects model.
Results After 1:1 PS matching, there were 6,102 patient pairs from Medicare and 6,934 pairs from MarketScan. Among them, patients with baseline CVD were 35.3% in Medicare and 14.0% in MarketScan. Baseline characteristics were well balanced between two treatment groups after matching (standardized mean difference <0.1). In Medicare cohort, abatacept consistently showed a decreased risk of composite CVD compared with TNFi in overall and each subgroup (Figure). However, in MarketScan cohort, where the population was younger than Medicare cohort, there was no association between abatacept and CVD compared to TNFi. After combining the two databases, abatacept was significantly associated with reduced risk of composite CVD outcome vs. TNFi in overall cohort (HR =0.79, 95% CI=0.67–0.92) and baseline CVD subgroup (HR =0.79, 95% CI=0.64–0.98). We also observed similar trend for secondary outcomes, where abatacept had decreased risk than TNFi.
Conclusions In this large multi-database population-based study of RA patients, abatacept treatment was associated with reduced risk of CVD compared to TNFi, especially among older population and patients with prior CVD conditions.
Disclosure of Interest None declared