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Opioid use doubled in patients with RA from 2002 to 2015
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Persistent opioid use among patients with rheumatoid arthritis doubled from 2002 to 2015, with pain and antidepressant treatment being the strongest predictors of taking opioids, according to data published in Arthritis & Rheumatology.
“Claims-based studies indicate that the prevalence of opioid prescriptions for individuals with RA increased substantially in the late 1990s and early 2000s, with rates stabilizing in the mid-2000s to mid-2010s,” Yvonne C. Lee, MD, MMSC, of Brigham and Women’s Hospital, and colleagues wrote. “While there is weak evidence that opioids are efficacious for the treatment of pain in RA, there is growing evidence that opioids are associated with serious risks, including non-vertebral fractures and serious infections. These observations highlight the importance of understanding the prevalence and predictors of chronic opioid use in RA.”
To analyze trends in the use of opioids among patients with RA, and identify the clinical predictors of opioid use, Lee and colleagues studied data from the Consortium of Rheumatology Researchers of North America (Corrona). According to the researchers, Corrona includes data on more than 42,000 patients with RA through 650 academic and community rheumatologists in 40 U.S. states. Patients in the database provided information on chronic opioid use —defined as any use reported during two or more consecutive study visits — through surveys obtained at clinical visits, which occurred as often as every 3 months.
The researchers focused on 33,739 Corrona participants with RA who completed 90 days or more of follow-up. In examining the predictors of chronic opioid use, they studied the 26,288 of those participants who were not taking opioids at baseline. Lee and colleagues applied Cox proportional hazards models to find associations between patient characteristics and incident chronic opioid use.
According to the researchers, chronic opioid use increased from 7.4% of participants with RA who had 90 days of follow up or more in 2002, to 16.9% in 2015. Severe pain (HR = 2.53; 95%, CI 2.192.92) and the use of antidepressants (HR = 1.79; 95% CI, 1.641.92) were associated with an increased risk for chronic opioid use. High disease activity (HR = 1.55; 95% CI, 1.31.84) and high disability (HR = 1.45; 95% CI, 1.271.65) were similarly associated with chronic opioid use. Asian race (HR = 0.49; 95% CI, 0.360.68) was associated with a decreased risk for chronic use.
“Severe baseline pain and antidepressant use were strongly associated with chronic opioid use, independent of RA disease activity, and baseline RA disease activity and disability were associated with chronic opioid use, independent of baseline pain,” Lee and colleagues wrote. “These data highlight the importance of: a) treating inflammatory disease activity aggressively with a treat-to-target strategy, and b) evaluating and treating pain and mental health problems, before prescribing opioid medications and in addition to treating with DMARDs.” – by Jason Laday
Disclosure: Lee reports an unpaid advisory board membership at Eli Lilly, stock ownership in Express Scripts and a research grant from Pfizer. Please see the study for all other authors’ relevant financial disclosures.
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