Yinzhu Jin1,2, Eun Ha Kang1,2, Gregory Brill1,2, Rishi J Desai1,2, Seoyoung C Kim3,4. 1. From the Division of Pharmacoepidemiology and Pharmacoeconomics, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. 2. Y. Jin, MS, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; E.H. Kang, MD, PhD, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, and Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital; G. Brill, MS, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; R.J. Desai, PhD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; S.C. Kim, MD, ScD, MSCE, Division of Pharmacoepidemiology and Pharmacoeconomics, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School. 3. From the Division of Pharmacoepidemiology and Pharmacoeconomics, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. skim62@partners.org. 4. Y. Jin, MS, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; E.H. Kang, MD, PhD, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, and Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital; G. Brill, MS, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; R.J. Desai, PhD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; S.C. Kim, MD, ScD, MSCE, Division of Pharmacoepidemiology and Pharmacoeconomics, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School. skim62@partners.org.
Abstract
OBJECTIVE: To evaluate the cardiovascular safety of abatacept (ABA) versus tumor necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients with and without underlying cardiovascular disease (CVD). METHODS: We identified RA patients with and without baseline CVD who initiated ABA or TNFi by using data from 2 large US insurance claims databases: Medicare (2008-2013) and Truven MarketScan (2006-2015). After stratifying by baseline CVD, ABA initiators were 1:1 propensity score (PS) matched to TNFi initiators to control for > 60 baseline covariates. Cox proportional hazards regression estimated the HR and 95% CI for a composite endpoint of CVD including myocardial infarction, stroke/transient ischemic stroke, or coronary revascularization in the PS-matched cohorts. HR from 2 databases were combined through an inverse variance-weighted fixed-effects model. RESULTS: We included 6102 PS-matched pairs of ABA and TNFi initiators from Medicare and 6934 pairs from MarketScan. Of these, 35.3% in Medicare and 14.0% in MarketScan had baseline CVD. HR (95% CI) for composite CVD in the overall ABA group versus TNFi was 0.67 (0.55-0.81) in Medicare and 1.08 (0.83-1.41) in MarketScan with the combined HR of 0.79 (0.67-0.92). Among patients with baseline CVD, the HR (95% CI) was 0.71 (0.55-0.92) in Medicare and 1.02 (0.68-1.51) in MarketScan, with the combined HR of 0.79 (0.64-0.98). CONCLUSION: In this large cohort of publicly or privately insured patients with RA in the United States, ABA was associated with a 20% reduced risk of CVD versus TNFi. While this observational study is subject to potential residual confounding, our results were consistent in patients with baseline CVD.
OBJECTIVE: To evaluate the cardiovascular safety of abatacept (ABA) versus tumornecrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients with and without underlying cardiovascular disease (CVD). METHODS: We identified RApatients with and without baseline CVD who initiated ABA or TNFi by using data from 2 large US insurance claims databases: Medicare (2008-2013) and Truven MarketScan (2006-2015). After stratifying by baseline CVD, ABA initiators were 1:1 propensity score (PS) matched to TNFi initiators to control for > 60 baseline covariates. Cox proportional hazards regression estimated the HR and 95% CI for a composite endpoint of CVD including myocardial infarction, stroke/transient ischemic stroke, or coronary revascularization in the PS-matched cohorts. HR from 2 databases were combined through an inverse variance-weighted fixed-effects model. RESULTS: We included 6102 PS-matched pairs of ABA and TNFi initiators from Medicare and 6934 pairs from MarketScan. Of these, 35.3% in Medicare and 14.0% in MarketScan had baseline CVD. HR (95% CI) for composite CVD in the overall ABA group versus TNFi was 0.67 (0.55-0.81) in Medicare and 1.08 (0.83-1.41) in MarketScan with the combined HR of 0.79 (0.67-0.92). Among patients with baseline CVD, the HR (95% CI) was 0.71 (0.55-0.92) in Medicare and 1.02 (0.68-1.51) in MarketScan, with the combined HR of 0.79 (0.64-0.98). CONCLUSION: In this large cohort of publicly or privately insured patients with RA in the United States, ABA was associated with a 20% reduced risk of CVD versus TNFi. While this observational study is subject to potential residual confounding, our results were consistent in patients with baseline CVD.
Authors: Fabiola Atzeni; Javier Rodríguez-Carrio; Călin D Popa; Michael T Nurmohamed; Gabriella Szűcs; Zoltán Szekanecz Journal: Nat Rev Rheumatol Date: 2021-04-08 Impact factor: 20.543
Authors: R Westhovens; S E Connolly; J Margaux; M Vanden Berghe; M Maertens; M Van den Berghe; Y Elbez; M Chartier; F Baeke; S Robert; M Malaise Journal: Rheumatol Int Date: 2020-06-17 Impact factor: 2.631
Authors: Ana M Fernández-Ortiz; Ana M Ortiz; Silvia Pérez; Esther Toledano; Lydia Abásolo; Miguel A González-Gay; Santos Castañeda; Isidoro González-Álvaro Journal: Arthritis Res Ther Date: 2020-09-11 Impact factor: 5.156
Authors: Gustavo Nogueira Schincariol Vicente; Ivânio Alves Pereira; Gláucio Ricardo Werner de Castro; Licia Maria Henrique da Mota; Ana Paula Carnieletto; Dhara Giovanna Santin de Souza; Fabiana Oenning da Gama; Ana Beatriz Vargas Santos; Cleandro Pires de Albuquerque; Manoel Barros Bértolo; Paulo Louzada Júnior; Rina Dalva Neubarth Giorgi; Sebastião Cezar Radominski; Maria Fernanda Brandão Resende Guimarães; Karina Rossi Bonfiglioli; Maria de Fátima Lobato da Cunha Sauma; Claiton Viegas Brenol; Geraldo da Rocha Castelar Pinheiro Journal: Adv Rheumatol Date: 2021-06-25