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Background  We examined the cardiovascular risk of abatacept compared with tumor necrosis factor ( TNF ) inhibitors in patients with rheumatoid arthritis with and without diabetes mellitus ( DM ).    Methods and Results  We conducted a cohort study of patients with rheumatoid arthritis who newly started abatacept or  TNF  inhibitors using claims data from Medicare and MarketScan. The primary outcome was a composite cardiovascular end point of myocardial infarction ( MI ), stroke/transient ischemic attack, and coronary revascularization. To account for >60 baseline characteristics, abatacept initiators were 1:1 propensity score ( PS ) matched to  TNF  initiators in each database. Cox proportional hazards models estimated hazard ratio ( HR ) and 95% confidence interval ( CI ) in the  PS ‐matched cohort per database. A fixed‐effects meta‐analysis pooled database‐specific  HR s. We included a total of 13 039  PS ‐matched pairs of abatacept and  TNF  inhibitor initiators (6103 pairs in Medicare and 6936 pairs in MarketScan). A total of 34.7% in Medicare and 19.8% in MarketScan had baseline  DM . The  HR  (95%  CI ) for the primary outcome associated with abatacept use versus  TNF  inhibitor was 0.81 (0.66–0.99) in Medicare and 0.95 (0.74–1.23) in MarketScan, with a pooled  HR  of 0.86 (95% CI, 0.73–1.01;  P =0.3 for heterogeneity). The risk of the primary outcome was lower in abatacept initiators versus  TNF  inhibitors in the  DM  subgroup, with a pooled  HR  of 0.74 (95% CI, 0.57–0.96;  P =0.7 for heterogeneity), but not in the non‐ DM  subgroup, with a pooled  HR  of 0.94 (95% CI, 0.77–1.14;  P =0.4 for heterogeneity).    Conclusions  In this large population‐based cohort of patients with rheumatoid arthritis, abatacept use appeared to be associated with a modestly reduced cardiovascular risk when compared with  TNF  inhibitor use, particularly in patients with DM.

journal of the american heart association

Comparative Cardiovascular Risk of Abatacept and Tumor Necrosis Factor Inhibitors in Patients With Rheumatoid Arthritis With and Without Diabetes Mellitus: A Multidatabase Cohort Study