Odds of opioid use in autoimmune rheumatic disease decreased 15% annually after 2014
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SAN DIEGO — The likelihood of opioid use among patients with autoimmune rheumatic disease has decreased annually by 15% since 2014, according to data presented at ACR Convergence 2023.
“The complexity and multifaceted nature of pain, especially in rheumatology, presents unique clinical challenges,” Titilola Falasinnu, MD, of the Stanford School of Medicine, told attendees.
According to Falasinnu, pain management paradigms have in recent years shifted away from opioid use. However, she noted that there are “limited data” on the exact nature of these shifts.
“Clinical guidelines for pain management are dated,” Falasinnu said. “Most of what we know about pain management in autoimmune and rheumatic diseases is limited to opioids. We know very little about recent changes in non-opioid pain management modalities.”
She later stressed that such information would be “foundational” for pain management across the spectrum of autoimmune and rheumatic diseases.
To analyze trends in pain management among patients with autoimmune rheumatic diseases, Falasinnu and colleges culled findings from the IBM MarketScan Database between 2007 and 2021. Included patients were those with one or more diagnostic code for ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjgren’s, systemic sclerosis, and systemic lupus erythematosus. Opioid use served as the primary outcome measure. Use of anticonvulsants, antidepressants, skeletal muscle relaxants, NSAIDS, topical pain medications and physical/occupational therapy were secondary endpoints.
The total study population included 141,962 patients, of whom 10,927 had AS, 21,438 had PsA, 71,393 were diagnosed with RA, 16,718 had Sjogren’s, 18,018 had SLE and 3,468 had SSc. The analysis included adjustments for calendar time, age, sex and region.
According to the researchers, the prevalence of opioid use increased from 26% in 2008 to 38% in 2014. This was followed by a reduction to 24% by 2020.
Meanwhile, the prevalence of physical therapy use doubled from 12% in 2008 to 24% in 2020. Anticonvulsants were used in 11% of patients in 2008 and then 24% in 2020. Between 2008 and 2014, the odds of opioid use increased annually by 3% (aOR = 1.03; 95% CI, 1.03-1.04). However, after 2014, opioid use decreased annually by 15% (aOR = 0.85; 95% CI, 0.84-0.86). Meanwhile, there was a 5% annual increase in physical therapy use through 2014 (aOR = 1.05; 95% CI, 1.04-1.06), followed by a 1% annual decrease thereafter (aOR = 0.99; 95% CI, 0.98-1).
Through 2014, the odds of anticonvulsant use increased annually by 8% (aOR = 1.08; 95% CI, 1.07-1.09), but did not change annually after this time point (aOR = 0.99; 95% CI, 0.99-1). A 9% annual increase was observed for topical analgesics through 2014 (aOR = 1.09; 95% CI, 1.07-1.1), while NSAID use decreased annually by 4% after 2014 (aOR = 0.96; 95% CI, 0.95-0.96).
An analysis of trends by disease demonstrated that in ankylosing spondylitis, PsA and RA, incidence of NSAID prescribing was highest. Meanwhile, the incidence of opioid and NSAID prescribing were lower for Sjgren’s disease, SLE and SSc than for the other three conditions.
In general, use of non-opioid pain management modalities has increased or plateaued recently, while opioid use declined after 2014, according to Falasinnu.
“NSAIDs remain the most popularly prescribed medications for pain,” she said. “This was the first and largest study to evaluate multiple pain modalities in multiple autoimmune and rheumatic diseases.”
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Falasinnu T. Abstract 2565. Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego.
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