Abatacept May Reduce Cardiovascular Risk in Rheumatoid Arthritis

Abatacept may have more favorable cardiovascular safety compared with TNF inhibitors in patients with RA with advanced age and presence of CVD at baseline.

For patients with rheumatoid arthritis (RA), abatacept is associated with a 20% reduced risk for cardiovascular disease (CVD) compared with tumor necrosis factor inhibitors (TNFi), according to results published in the Journal of Rheumatology. These results applied to patients both with and without CVD at baseline.

The study included participants with RA with and without CVD at baseline who initiated abatacept or TNFi, identified from 2 large insurance claims databases: Medicare (2008 to 2013) and Truven MarketScan (2006 to 2015). Participants who initiated abatacept were 1:1 propensity score (PS)-matched to participants who initiated TNFi to control for >60 baseline covariates. The primary end point was CVD, including myocardial infarction, stroke or transient ischemic stroke, or coronary revascularization in the PS-matched cohorts.

The analysis included 6102 PS-matched pairs from Medicare and 6934 from MarketScan. In the Medicare group, 35.3% of participants had baseline CVD, and 14.0% of participants in the MarketScan group had baseline CVD.

The hazard ratio (HR) for composite CVD among participants taking abatacept vs TNFi was 0.67 (95% CI, 0.55-0.81) among Medicare participants and 1.08 (95% CI, 0.83-1.41) among MarketScan participants, producing a combined HR of 0.79 (95% CI, 0.64-0.98).

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For participants who had CVD at baseline, the HR was 0.71 (95% CI, 0.55-0.92) for Medicare participants and 1.02 (95% CI, 0.68-1.51) for MarketScan participants, with a combined HR of 0.79 (95% CI, 0.64-0.98).

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Jin Y, Kang EH, Brill G, Desai RJ, Kim SC. Cardiovascular (CV) risk after initiation of abatacept versus TNF inhibitors in rheumatoid arthritis patients with and without baseline CV disease [published online May 15, 2018]. J Rheumatol. doi: 10.3899/jrheum.170926