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Opioid use may increase infection risk for patients with RA
Use of opioid analgesics by patients with rheumatoid arthritis may increase the risk for hospitalization due to serious infection, according to researchers from Vanderbilt University Medical Center.
Researchers identified 1,790 adult patients with rheumatoid arthritis (RA) from a cohort of 13,796 patients with RA and information in the Tennessee Medicaid database. Patients included in the study had at least one billing code for RA and a prescription fulfillment of either adalimumab, cyclophosphamide, cyclosporine, D-penicillamine, etanercept, gold salts, hydroxychloroquine, infliximab, leflunomide, methotrexate, minocycline or sulfasalazine. The researchers identified the incidence of serious infection and opiate use among the self-controlled case series (SCCS) cohort.
The incidence rate of at least one use of opioids was 95% in the SCCS cohort compared with 87.3% for the overall cohort. Use in the SCCS cohort included hydrocodone (48%), propoxyphene (22.3%), oxycodone (12.8%), morphine (5.7%), codeine (5%) and other opioids (6.2%).
Analysis showed an incidence rate ratio (IRR) of 1.73 for infection at an exposure to opioids in the SCCS cohort compared with non-use of opioids and an IRR of 1.39 after adjusting for age, season, nursing home residency and medication use. In an analysis for new use of opioids, the IRR was 2.38 for serious infection compared with non-use.
Compared with non-use, current long-acting or short-acting opioid use was associated with an increased risk for serious infection. Investigators found a fixed confounder-adjusted IRR of 2.81 for long-acting opioids and an IRR of 1.66 for short-acting opioids. The highest infection risk was observed for the highest morphine-equivalent doses. No statistically significant difference was seen after adjustments for NSAID use. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.