Abatacept, Infliximab, Adalimumab: Which RA Drug Carries the Highest Diabetes Risk?

According to a study, rheumatoid arthritis (RA) drug abatacept carries a lower risk of incident diabetes mellitus (DM) than infliximab or adalimumab.

“Focusing on DM prevention efforts in patients with RA may be important to improve cardiovascular outcomes and reduce early mortality. 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,” the researchers explained.

This was a new-user observational cohort study that collected data from the Truven MarketScan claims database spanning 2005 through 2016 and the public Medicare claims database spanning 2010 through 2014. RA patients who did not have DM at baseline were placed into one of eight exposure groups: abatacept, infliximab, adalimumab, golimumab, certolizumab, etanercept, tocilizumab, or tofacitinib. The primary outcome was incident DM, which was defined as a diagnosis code plus initiation of a hypoglycemic treatment.

Data for 50,505 RA patients from the Truven and 17,251 from the Medicare databases were collected. The DM incident rate for the Truven database was 6.8 (95% confidence interval [CI], 6.1 to 7.6) per 1,000 person-years, and for Medicare was 6.6 (95% CI, 5.4 to 7.9) per 1,00 person-years. When adjusting for 56 confounding variables, the pooled hazard ratio for the etanercept versus abatacept comparison was not statistically significantly elevated (1.65; 95% CI, 0.91 to 2.98). Effect estimates comparing certolizumab, golimumab, tocilizumab, and tofacitinib with abatacept were considered imprecise due to a small sample size.

The study results were published in ACR Open Rheumatology.

“In conclusion, we observed a lower risk of incident DM in patients with RA initiating abatacept compared with patients with RA initiating infliximab or adalimumab. A limited number of DM events and incomplete capture of important risk factors for DM development, including obesity and RA disease activity, in administrative claims used to conduct this study precludes a causal conclusion. Future randomized prospective studies are necessary to determine the causality of this association,” summarized the study authors.