Friday, 21 Sep 2018

You are here

Less Cardiovascular Risk with Abatacept in Rheumatoid Arthritis

A claims data analysis shows that abatacept use in rheumatoid arthritis (RA) patients yielded a modestly reduced cardiovascular risk when compared to patients receiving TNF inhibitors (TNFi).

Using claims data from Medicare and MarketScan, researchers from Harvard assessed the frequency of cardiovascular (CV) outcomes in RA patients receiving either ABA or TNFi.  The primary outcome was a composite cardiovascular end point of myocardial infarction (MI), stroke/transient ischemic attack, and coronary revascularization.

The study included 13 039 PS‐matched patients on either abatacept (ABA) or TNFi.  Background diabetes (DM) was found 34.7% of Medicare and 19.8% of MarketScan patients.

CV events were less frequent with abatacept use versus TNF inhibitor; the HR 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).

While those with diabetes had an even lower CV event rate for ABA vs. TNFi (HR 0.74; 95%CI 0.57–0.96; P=0.7) for heterogeneity), the same was not seen in those without diabetes  (pooled HR 0.94; 95% CI, 0.77–1.14; P=0.4).

In RA patients, ABA was be associated with a modest reduction in cardiovascular risk (compared with TNFi), particularly in patients with DM.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Unproven But Profitable Stem Cell Clinics

Stem cell clinics are popular and proliferating as they are largely a cash business and fall outside of FDA regulatory control. In lieu of scientific proof, most advocates use patient testimonials and the placebo effect to back up their claims.

Out of Pocket Costs for Biosimilars - No Savings So Far

JAMA has published an analysis showing that under Medicare Part D, RA biosimilar infliximab-dyyb was only moderately less expensive (18% less) than the biologic infliximab and, owing to differences in gap discounts, the out of pocket costs for the biosimilar was nearly $1700 more than infliximab in 2017.

Cutting Oral JAK 1/2 Inhibitor Dose an Option in RA

Many patients with rheumatoid arthritis (RA) who achieved sustained disease control with baricitinib (Olumiant) treatment were able to reduce their daily dose from 4 mg to 2 mg and maintain their response, a double-blind substudy of a long-term extension trial found.

Tocilizumab Equals other Biologics in Cardiovascular Risk

An odd side effect of several new agents is the risk of hyperlipidemia. While this has been seen with tocilizumab (TCZ), there does not appear to be a resultant risk of cardiovascular (CV) events. A study of claims data compared CV risk in rheumatoid arthritis (RA) patients receiving TOC (an IL6 receptor antagonists) and other biologics and found no differences with regard to CV outcomes.

Treatment Preferences in Still’s Disease

In July 2018, RheumNow launched a “Live Vote” survey of US and non-US rheumatologists that asked how they diagnose and treat systemic juvenile idiopathic arthritis (sJIA), also known as “Still’s disease”. It appears that many prefer to start therapy with an IL-1 inhibitor, after a course of steroids and MTX/DMARD. Yet, these findings suggest there are significant unmet needs in the diagnosis and management of sJIA patients.