Patel Vardhaman, Pulungan Zulkarnain, Shah Anne, Jones Barton, Petrilla Allison, Ferri Leticia, Han Xue, Michaud Kaleb
Bristol Myers Squibb, Lawrence Township, NJ, USA.
Avalere Health, Washington, DC, USA.
Rheumatol Ther. 2022 Aug;9(4):1091-1107. doi: 10.1007/s40744-022-00453-w. Epub 2022 May 23.
Targeted DMARD (tDMARD) use in patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) may increase whole-body insulin sensitivity. Evidence comparing the T2DM-related clinical and economic impact of abatacept versus other tDMARDs is limited. This study compared differences in T2DM-related healthcare resource utilization (HCRU) and costs in patients with RA and T2DM.
This retrospective study used 100% Medicare Fee-for-Service claims (parts A/B/D) to identify patients ≥ 65 age, diagnosed with RA and T2DM, and were either TNFi-experienced (switched from a TNFi to another tDMARD) or tDMARD-naïve, initiating their first tDMARD (abatacept, TNFi, or non-TNFi) between 2010 and 2017. Abatacept users were propensity-score (PS) matched to TNFi and other non-TNFi users separately on baseline demographics, comorbidities, medications, T2DM-related HCRU, and costs. Post-index follow-up: until discontinuation of index treatment, disenrollment, death, or end of study period, whichever occurred first. T2DM-related complications and HCRU were assessed. Costs were normalized to per-patient-per-month (PPPM) and inflated to 2019 US$.
The TNFi-experienced group included 2169 abatacept/TNFi and 2118 abatacept/other non-TNFi PS-matched pairs; the tDMARD-naïve group included 2667 abatacept/TNFi and 2247 abatacept/other non-TNFi PS-matched pairs. For TNFi-experienced patients, T2DM-related complication rates for inpatient settings PPPM trended lower for abatacept than TNFi (21 vs. 24, p = 0.046) and other non-TNFi groups (21 vs. 26; p < 0.0001). T2DM-related total costs PPPM for TNFi-experienced patients demonstrated lower trends for abatacept than TNFi ($489 vs. $594, p = 0.016) and other non-TNFi users ($493 vs. $606, p = 0.012).
Medicare beneficiaries with RA and T2DM who switch to/initiate abatacept as their first tDMARD have directionally lower rates and costs of T2DM-related complications compared with patients switching to/initiating other tDMARDs. Abatacept treatment may help reduce clinical and economic burdens associated with T2DM in patients with RA.
在类风湿关节炎（RA）和2型糖尿病（T2DM）患者中使用靶向病情缓解抗风湿药（tDMARD）可能会提高全身胰岛素敏感性。比较阿巴西普与其他tDMARD对T2DM相关临床和经济影响的证据有限。本研究比较了RA和T2DM患者中T2DM相关医疗资源利用（HCRU）和成本的差异。
这项回顾性研究使用100%的医疗保险按服务付费索赔（A/B/D部分）来识别年龄≥65岁、诊断为RA和T2DM的患者，这些患者要么有肿瘤坏死因子抑制剂（TNFi）使用经验（从TNFi转换为另一种tDMARD），要么是初治tDMARD患者，在2010年至2017年间开始使用他们的第一种tDMARD（阿巴西普、TNFi或非TNFi）。阿巴西普使用者在基线人口统计学、合并症、药物治疗、T2DM相关HCRU和成本方面分别与TNFi使用者和其他非TNFi使用者进行倾向评分（PS）匹配。索引后随访：直至索引治疗停药、退出研究、死亡或研究期结束，以先发生者为准。评估T2DM相关并发症和HCRU。成本按每位患者每月（PPPM）进行标准化，并折算为2019年美元。
有TNFi使用经验的组包括2169对阿巴西普/TNFi和2118对阿巴西普/其他非TNFi PS匹配对；初治tDMARD组包括2667对阿巴西普/TNFi和2247对阿巴西普/其他非TNFi PS匹配对。对于有TNFi使用经验的患者，阿巴西普组的住院环境中T2DM相关并发症发生率PPPM趋势低于TNFi组（21比24，p = 0.046）和其他非TNFi组（21比26；p < 0.0001）。有TNFi使用经验的患者的T2DM相关总成本PPPM显示，阿巴西普组的趋势低于TNFi组（489美元对594美元，p = 0.016）和其他非TNFi使用者（493美元对606美元，p = 0.012）。
与改用/开始使用其他tDMARD的患者相比，改用/开始使用阿巴西普作为第一种tDMARD的RA和T2DM医疗保险受益人在T2DM相关并发症的发生率和成本方面有降低的趋势。阿巴西普治疗可能有助于减轻RA患者中与T2DM相关的临床和经济负担。
