Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
J Am Heart Assoc. 2018 Jan 24;7(3):e007393. doi: 10.1161/JAHA.117.007393.
We examined the cardiovascular risk of abatacept compared with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis with and without diabetes mellitus (DM).
We conducted a cohort study of patients with rheumatoid arthritis who newly started abatacept or TNF inhibitors using claims data from Medicare and MarketScan. The primary outcome was a composite cardiovascular end point of myocardial infarction (MI), stroke/transient ischemic attack, and coronary revascularization. To account for >60 baseline characteristics, abatacept initiators were 1:1 propensity score (PS) matched to TNF initiators in each database. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) in the PS-matched cohort per database. A fixed-effects meta-analysis pooled database-specific HRs. We included a total of 13 039 PS-matched pairs of abatacept and TNF inhibitor initiators (6103 pairs in Medicare and 6936 pairs in MarketScan). A total of 34.7% in Medicare and 19.8% in MarketScan had baseline DM. The HR (95% CI) for the primary outcome associated with abatacept use versus TNF inhibitor 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; =0.3 for heterogeneity). The risk of the primary outcome was lower in abatacept initiators versus TNF inhibitors in the DM subgroup, with a pooled HR of 0.74 (95% CI, 0.57-0.96; =0.7 for heterogeneity), but not in the non-DM subgroup, with a pooled HR of 0.94 (95% CI, 0.77-1.14; =0.4 for heterogeneity).
In this large population-based cohort of patients with rheumatoid arthritis, abatacept use appeared to be associated with a modestly reduced cardiovascular risk when compared with TNF inhibitor use, particularly in patients with DM.
我们研究了类风湿关节炎患者在合并或不合并糖尿病（DM）的情况下，使用阿巴西普与肿瘤坏死因子（TNF）抑制剂的心血管风险。
我们使用来自 Medicare 和 MarketScan 的索赔数据，对新开始使用阿巴西普或 TNF 抑制剂的类风湿关节炎患者进行了队列研究。主要结局是心肌梗死（MI）、卒中和短暂性脑缺血发作以及冠状动脉血运重建的复合心血管终点。为了考虑到 >60 个基线特征，阿巴西普的起始者在每个数据库中都与 TNF 起始者进行了 1:1 的倾向评分（PS）匹配。在 PS 匹配队列中，Cox 比例风险模型估计了每个数据库的风险比（HR）和 95%置信区间（CI）。对数据库特异性 HR 进行了固定效应荟萃分析。我们共纳入了 13039 对 PS 匹配的阿巴西普和 TNF 抑制剂起始者（Medicare 中有 6103 对，MarketScan 中有 6936 对）。在 Medicare 中有 34.7%，在 MarketScan 中有 19.8%的患者基线时患有 DM。与 TNF 抑制剂相比，阿巴西普使用与主要结局相关的 HR（95%CI）在 Medicare 中为 0.81（0.66-0.99），在 MarketScan 中为 0.95（0.74-1.23），汇总 HR 为 0.86（95%CI，0.73-1.01；=0.3 用于异质性检验）。在 DM 亚组中，与 TNF 抑制剂相比，阿巴西普起始者的主要结局风险较低，汇总 HR 为 0.74（95%CI，0.57-0.96；=0.7 用于异质性检验），但在非 DM 亚组中，汇总 HR 为 0.94（95%CI，0.77-1.14；=0.4 用于异质性检验）。
在这项基于人群的大型类风湿关节炎患者队列研究中，与使用 TNF 抑制剂相比，阿巴西普的使用似乎与心血管风险的适度降低相关，尤其是在合并 DM 的患者中。
Zotero 插件
