OA disease severity, patient frustration growing despite rising opioid use
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Physicians across five countries in Europe reported decreasing satisfaction with treatment for their patients with osteoarthritis, as well as increasing disease severity despite the rising use of opioids, according to findings presented at EULAR 2020.
“Osteoarthritis management uses a mixture of nonpharmacological and pharmacological therapy, but most people we know tend to use drug therapies,” Philip G. Conaghan, MBBS, PhD, FRACP, FRCP, of the University of Leeds, told attendees on the webcast. “Also, we know they are not very effective and that we have real safety and tolerability issues for both NSAIDs and opioids.”
To examine the current, real-world treatment paradigm for OA as it related to disease severity across several European Union nations, Conaghan and colleagues studied data from the 2017-18 Adelphi OA Disease Specific Programme, itself a study of physicians and their patients. The researchers included data for 489 physicians — in primary care, rheumatology and orthopedics — from France, Germany, Italy, Spain and the United Kingdom. These physicians reported on 3,596 patients.
Physicians in the data set classified their patients as having mild, moderate or severe disease, and provided information on currently prescribed OA therapies along with satisfaction with said therapy. Satisfaction was assessed using a rating system ranging from “very satisfied” to “very dissatisfied.” Patients with back and neck OA only were excluded form the study. Conaghan and colleagues compared disease severity groups using analysis of variance and chi-squared tests.
According to Conaghan, 24% of patients were classified by their physician as having mild disease, with 53% as moderate and 23% as severe. Overall, 73% of patients were prescribed at least one drug for OA, including 65% of those with mild disease, 76% with moderate disease and 77% with severe disease status (P < .001). Paracetamol was the most prescribed drug, with 34% of patients receiving it. Other frequently prescribed treatments included NSAIDs, with 31%, and opioids, with 27%.
Worsening disease severity was associated with increased opioid use, with 11% among mild, 25% among moderate and 47% among severe cases (P < .001). The mean number of prescriptions for each patients also increased with worsening severity, with 0.9 for mild, 1.4 for moderate and 1.6 for severe cases, while physician satisfaction with treatment decreased, with 86% for mild, 70% for moderate and 41% for severe cases (P < .001).
“Now, we have to be careful, as these are cross-sectional data and we can’t say how people are changing in their therapy use over time, but we do see some trends coming out of this work, with increased symptom severity, decreased employment, increasing BMI and number of comorbidities and especially an increase in the number of painful joints that people have,” Conaghan said. “We see opioids — especially strong opioids — increasingly used with disease severity, and less use of monotherapy in that group, and a lot dissatisfaction with existing therapies, that says to us all that we definitely need new therapies.”
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Conaghan PG, G. Understanding current prescription drug treatment paradigms for patients with osteoarthritis in Europe. Presented at EULAR 2020 Congress; June 3-6 (virtual meeting).
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