ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 20

Diabetes and Other Comorbidities in Rheumatoid Arthritis Patients Starting a Biologic DMARD: A Multi-Database Cohort Study

Seoyoung C. Kim1,2, Yinzhu Jin3, Gregory Brill4, Jennifer Lewey4,5, Nam-Kyong Choi3, Elisabetta Patorno4 and Rishi J. Desai3, 1Rheumatology, Immunology and Allergy and Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA, 2Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA, 3Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA, 4Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, 5Division of Cardiology, Columbia University Medical Center, New York, NY

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Epidemiology and Public Health - Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:  Patients with rheumatoid arthritis (RA) are known to have an increased comorbidity burden. Presence of diabetes or other comorbidities such as cardiovascular disease (CVD) may affect the treatment decisions for RA. Limited information is available regarding biologic initiation patterns in RA patients with various comorbid conditions. We aimed to compare the frequency of diabetes and other comorbidities in RA patients starting different classes of biologic DMARDs.

Methods:  Using longitudinal claims data from Medicaid (2000-2010), Medicare (2008-2013) and a commercial health plan (MarketScan 2006-2015), we conducted a cohort study that included RA patients who initiated a biologic DMARD. We included 3 categories of biologic DMARDs: 1) TNF inhibitors (TNFi), 2) abatacept and 3) other biologics including rituximab, tocilizumab and tofacitinib. Patients were required to be naive to all biologic DMARDs for at least 365 days prior to the date of the 1st biologic drug dispensing (i.e., index date). We assessed the prevalence of diabetes and other comorbidities in the 365-day period prior to the index date in each data source.

Results: There were a total of 148,584 biologic DMARD initiators: 25,878 in Medicaid, 40,663 in Medicare and 81,831 in MarketScan. Mean age (SD) in years was 46.8 (12.0) in Medicaid, 73.1 (6.3) in Medicare and 53.7 (13.0) in MarketScan. Over 75% were female. Across all three databases, 115,903 (78%) started a TNFi, 13,547 (9%) abatacept and 18,922 (13%) other biologics. Diabetes was common, affecting 22.8% in Medicaid, 35.3% in Medicare and 17.7% in MarketScan. Hypertension (36.1-78.6%), hyperlipidemia (21.3-67.7%), coronary heart disease (8.3-30.0%), heart failure (2.7-14.7%) and other cardiovascular comorbidities were common in all three databases. Compared to abatacept or other biologic initiators, TNFi initiators were younger and had a lower proportion of CV comorbidities including coronary heart disease, heart failure, stroke, and atrial fibrillation and malignancy at baseline. Differences in diabetes prevalence across treatment groups were less pronounced (Table).

Conclusion: Diabetes and CV comorbidities were common in RA patients starting a biologic DMARD across all three databases. Cardiovascular comorbidity profile was different in TNFi initiators compared to initiators of abatacept or other biologics. Our findings highlight the need for future research accounting for these differences appropriately in comparative effectiveness and safety studies of biologic DMARDs in multimorbid RA patients to inform treatment decisions.

Table. Baseline characteristics of different biologic starters

TNFi

Abatacept

Other biologics

N
Medicaid

24,647

498

733

Medicare

25,792

6,107

8,764

MarketScan

65,464

6,942

9,425

Age, years
Medicaid

46.8±11.9

48.7±12.0*

48.1±12.6*

Medicare

72.6±6.1

73.8±6.3*

74.2±6.6*

MarketScan

52.8±12.9

56.9±13.0*

57.9±13.1*

Diabetes
Medicaid

22.6%

24.1%

30.0%*

Medicare

35.5%

34.8%

35.3%

MarketScan

16.9%

19.8%*

21.7%*

Coronary heart disease
Medicaid

8.8%

11.2%

12.8%*

Medicare

28.2%

31.6%*

34.2%*

MarketScan

7.3%

12.3%*

12.6%*

Heart failure
Medicaid

4.2%

6.0%*

10.8%*

Medicare

12.7%

17.4%*

18.8%*

MarketScan

2.0%

5.2%*

6.2%*

Stroke
Medicaid

2.2%

3.8%*

4.1%*

Medicare

6.7%

7.2%

7.9%*

MarketScan

1.7%

2.7%*

3.3%*

Atrial fibrillation
Medicaid

1.1%

2.2%*

2.7%*

Medicare

10.3%

14.1%*

15.4%*

MarketScan

2.2%

4.4%*

5.4%*

Hypertension
Medicaid

35.6%

41.2%*

50.0%*

Medicare

78.2%

80.3%*

78.9%

MarketScan

36.5%

44.2%*

48.0%*

Hyperlipidemia
Medicaid

21.1%

23.7%

26.1%*

Medicare

67.3%

69.3%*

68.0%

MarketScan

29.9%

34.3%*

36.4%*

Malignancy
Medicaid

3.5%

3.6%

26.9%*

Medicare

14.6%

16.9%*

48.3%*

MarketScan

5.6%

9.2%*

24.4%*

*p<0.05 compared to TNFi
Disclosure: S. C. Kim, Pfizer, Lilly, Genentech, AstraZeneca, and Bristol-Myers Squibb, 2; Y. Jin, None; G. Brill, None; J. Lewey, None; N. K. Choi, National Research Foundation of Korea (NRF-2014R1A1A2058601 and NRF-2015K2A1A2070210), 2; E. Patorno, None; R. J. Desai, None.

To cite this abstract in AMA style:

Kim SC, Jin Y, Brill G, Lewey J, Choi NK, Patorno E, Desai RJ. Diabetes and Other Comorbidities in Rheumatoid Arthritis Patients Starting a Biologic DMARD: A Multi-Database Cohort Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/diabetes-and-other-comorbidities-in-rheumatoid-arthritis-patients-starting-a-biologic-dmard-a-multi-database-cohort-study/. Accessed .

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