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Objective  The objective of this study is to compare the risk of incident diabetes mellitus ( DM ) in patients with rheumatoid arthritis ( RA ) treated with biologic or targeted synthetic disease‐modifying antirheumatic drugs.    Methods  A new‐user observational cohort study was conducted using data from a  US  commercial (Truven MarketScan, 2005‐2016) claims database and a public insurance (Medicare, 2010‐2014) claims database. Patients with  RA  who did not have  DM  were selected into one of eight exposure groups (abatacept, infliximab, adalimumab, golimumab, certolizumab, etanercept, tocilizumab, or tofacitinib) and observed for the outcome of incident  DM , defined as a combination of a diagnosis code and initiation of a hypoglycemic treatment. A stabilized inverse probability–weighted Cox proportional hazards model was used to account for 56 confounding variables and estimate hazard ratios ( HR s) and 95% confidence intervals ( CI s). All analyses were conducted separately in two databases, and estimates were combined using inverse variance meta‐analysis.    Results  Among a total of 50 505 patients with  RA  from Truven and 17 251 patients with  RA  from Medicare, incidence rates (95%  CI ) for  DM  were 6.8 (6.1‐7.6) and 6.6 (5.4‐7.9) per 1000 person‐years, respectively. After confounding adjustment, the pooled  HR s (95%  CI ) indicated a significantly higher risk of  DM  among adalimumab (2.00 [1.11‐3.03]) and infliximab initiators (2.34 [1.38‐3.98]) compared with abatacept initiators. The pooled  HR  (95%  CI ) for the etanercept versus abatacept comparison was elevated but not statistically significant (1.65 [0.91‐2.98]). The effect estimates for certolizumab, golimumab, tocilizumab, and tofacitinib, compared with abatacept, were highly imprecise because of a limited sample size.    Conclusion  Initiation of abatacept was associated with a lower risk of incident  DM  in patients with  RA  compared with infliximab or adalimumab.

acr open rheumatology

Comparative Risk of Diabetes Mellitus in Patients With Rheumatoid Arthritis Treated With Biologic or Targeted Synthetic Disease‐Modifying Drugs: A Cohort Study