OBJECTIVES: Abatacept, a biologic DMARD, was associated with respiratory adverse 
events in a small subgroup of RA patients with chronic obstructive pulmonary 
disease (COPD) in a trial. Whether this potential risk is specific to abatacept 
or extends to all biologics and targeted synthetic DMARDs (tsDMARDs) is unclear. 
We assessed the risk of adverse respiratory events associated with biologic and 
tsDMARDs compared with conventional synthetic DMARDs (csDMARDs) among RA 
patients with concomitant COPD in a large, real-world cohort.
METHODS: We used a prevalent new-user design to study RA patients with COPD in 
the US-based MarketScan databases. New users of biologic DMARDs and/or tsDMARDs 
were matched on time-conditional propensity scores to new users of csDMARDs. 
Adverse respiratory events were estimated using Cox models comparing current use 
of biologic/tsDMARDs with csDMARDs.
RESULTS: The cohort included 7424 patients initiating biologic/tsDMARDs and 7424 
matched patients initiating csDMARDs. The adjusted hazard ratio of hospitalized 
COPD exacerbation comparing biologic/tsDMARD vs csDMARD was 0.76 (95% CI: 0.55, 
1.06), while it was 1.02 (95% CI: 0.82, 1.27) for bronchitis, 1.21 (95% CI: 
0.92, 1.58) for hospitalized pneumonia or influenza and 0.99 (95% CI: 0.87, 
1.12) for outpatient pneumonia or influenza. The hazard ratio of the combined 
end point of COPD exacerbation, bronchitis and hospitalized pneumonia or 
influenza was 1.04 (95% CI: 0.89, 1.21).
CONCLUSION: In this large, real-world comparative safety study, biologic and 
tsDMARDs, including abatacept, were not associated with an increased risk of 
adverse respiratory events when compared with csDMARDs in patients with RA and 
COPD.