Abatacept Lowers Diabetes Risk in RA

Abatacept (Orencia, Bristol Myers Squibb), a T-cell co-stimulation modulator for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis, appears to lower the risk of diabetes mellitus in patients with rheumatoid arthritis who are receiving biologic or targeted synthetic DMARDs.

The report, published on April 20 in ACR Open Rheumatology, is based on an analysis of two claims databases over a four-year period (2010-2014). The study included patients with rheumatoid arthritis who did not have diabetes and who were taking either abatacept, infliximab, adalimumab, golimumab, certolizumab, etanercept, tocilizumab, or tofacitinib.

Of, 50,505 patients from Truven claims database and 17,251 patients from Medicare, the incident rates for diabetes was 6.8 (6.1‐7.6 range) and 6.6 (5.4‐7.9 range) per 1,000 person‐years, respectively. Compared with abatacept, researchers found a significantly higher risk of diabetes among patients who took adalimumab (2.00 [1.11‐3.03]) and infliximab (2.34 [1.38‐3.98]). For patients receiving etanercept, the results were not statistically significant, and for certolizumab, golimumab, tocilizumab, and tofacitinib, risk could not be determined due to small sample sizes.

Diabetes affects half of all rheumatoid arthritis patients. The systemic inflammatory process in rheumatoid arthritis can lead to insulin resistance and diabetes mellitus. But the reverse can occur as well:  Diabetes can raise the risk of rheumatoid arthritis. And, for patients with diabetes and rheumatoid arthritis, the risk of having a major cardiovascular adverse event increases threefold.

"Focusing on diabetes mellitus prevention efforts in patients with rheumatoid arthritis (RA) may be important to improve cardiovascular outcomes and reduce early mortality," wrote authors who were led by Rishi J. Desai, Ph.D., of Brigham and Women's Hospital, Boston. "Many biologic and targeted synthetic disease‐modifying antirheumatic drugs (DMARDs) directed toward specific components of the immune system, including tumor necrosis factor (TNF)–alpha, interleukins, Janus kinase enzyme, and T cells, have been successfully developed to target inflammation control in RA. Some preliminary evidence from observational studies has revealed a potentially lower risk of DM with TNF‐alpha inhibitors (TNF‐inhibitors), as well as with abatacept (a T‐cell co‐stimulation inhibitor), compared with nonbiologic disease‐modifying agents, which have general immunosuppressive properties."

REFERENCE

Rishi J. Desai  Sara Dejene  Yinzhu Jin  Jun Liu  Seoyoung C. Kim. "Comparative Risk of Diabetes Mellitus in Patients With Rheumatoid Arthritis Treated With Biologic or Targeted Synthetic Disease‐Modifying Drugs: A Cohort Study," ACR Open Rheumatology. April 8, 2020. https://doi.org/10.1002/acr2.11124