Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Opioid prescribing in the U.S. has increased at an alarming rate amid uncertainty over effectiveness and rising concerns over safety of this practice. Patients with systemic inflammatory diseases (SID) often suffer from chronic pain, and may be more likely to be prescribed opioids compared to those without SID. We investigated the rates of opioid prescribing in SID patients compared to age, sex and index date-matched patients with hypertension (HTN) but no SID.
Methods: We conducted a cohort study using insurance claims data from Truven MarketScan (2003-2014). We identified individuals aged >18 years with prevalent SID [i.e., rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] based on a combination of ≥2 diagnosis codes and ≥1 dispensing for disease-specific drug dispensing and defined the dispensing date of the disease-specific prescription as the index date. We matched each SID patient 1:1 by age, sex and index date to a HTN patients, identified using >2 diagnosis codes for HTN and >1 dispensing for antihypertensive medication. We excluded patients with any malignancy. All patients were required to have ≥1 year of continuous enrollment before and after the index date. We assessed prescription opioid use during the 1-year follow-up from the index date in the SID group compared to HTN group.
Results: We identified 181,922 RA (77% female, mean age 55), 45,879 SLE (91% female, mean age 47), 30,346 PsA (51% female, mean age 50) and 7,704 AS (39% female, mean age 45) patients, matched to HTN patients. At baseline, depression and fibromyalgia were more prevalent in SID cohort compared to matched HTN patients, while diabetes and cardiovascular disease were more common in HTN patients. Back pain was most prevalent among AS cohort (16%) compared to 4% in the matched HTN cohort (p<0.001). During 1 year follow-up, >1 opioid prescription was dispensed among 46% RA (vs. 32% HTN, p<0.001), 46% SLE (vs. 33% HTN, p<0.001), 41% PsA (vs. 31% HTN, p<0.001), and 50% AS (vs. 30% HTN, p<0.001) patients. Long-term opioid use (>90 days), and extended-acting opioid prescriptions also showed similar trends, with higher rates seen in SID cohorts compared to HTN, and highest use seen among AS patients (Table).
Conclusion: Nearly half of SID patients and approximately 30 % of HTN patients used prescription opioids during a 1-year period. The highest percentage of opioid dispensing were seen among patients with AS. Compared to HTN patients, SID patients had more frequent use of any opioids, multiple types or long-acting opioids. Long-term use was also more common in SID patients.
|
Table. Patient characteristics at baseline and their prescription opioid use patterns during 1-year followup |
||||||||
|
RA |
SLE |
PsA |
AS |
|||||
|
SID |
Matched HTN |
SID |
Matched HTN |
SID |
Matched HTN |
SID |
Matched HTN |
|
|
N=181,922 |
N=181,922 |
N=45,879 |
N=45,879 |
N=30,346 |
N=30,346 |
N=7,704 |
N=7,704 |
|
|
Baseline characteristics |
|
|
|
|
||||
|
Age (SD) |
55.3 (13.1) |
55.3 (13.1) |
47.1 (13.1) |
47.1 (13.1) |
49.7 (11.5) |
49.7 (11.5) |
44.6 (12.0) |
44.6 (12.0) |
|
% Female |
77% |
77% |
91% |
91% |
51% |
51% |
39% |
39% |
|
Baseline opioid use |
47% |
31% |
46% |
32% |
41% |
30% |
52% |
31% |
|
Substance use |
1% |
1% |
1% |
1% |
1% |
1% |
1% |
2% |
|
Smoking |
4% |
4% |
4% |
4% |
3% |
5% |
4% |
5% |
|
Depression |
9% |
9% |
12% |
11% |
10% |
9% |
12% |
9% |
|
Fibromyalgia |
10% |
3% |
16% |
4% |
8% |
3% |
12% |
3% |
|
Diabetes |
13% |
21% |
9% |
17% |
14% |
19% |
8% |
17% |
|
Back pain |
6% |
5% |
7% |
5% |
7% |
4% |
16% |
4% |
|
Migraine headache |
3% |
3% |
7% |
5% |
3% |
3% |
4% |
4% |
|
Osteoarthritis |
31% |
12% |
17% |
8% |
25% |
9% |
20% |
7% |
|
Chronic kidney disease |
2% |
3% |
8% |
2% |
2% |
2% |
2% |
2% |
|
NSAID use |
46% |
23% |
35% |
24% |
46% |
22% |
53% |
22% |
|
Benzodiazepine use |
17% |
16% |
21% |
16% |
15% |
14% |
18% |
13% |
|
Outcome during 1-year follow-up |
|
|
|
|
||||
|
% patients with >1 opioid Rx |
46% |
32% |
46% |
33% |
41% |
31% |
50% |
30% |
|
% patients with >2 types of opioid Rx |
16% |
8% |
15% |
9% |
13% |
8% |
19% |
8% |
|
% patients with immediate-acting opioid Rx |
46% |
31% |
46% |
33% |
40% |
31% |
49% |
30% |
|
% patients with extended-acting opioid Rx |
5% |
2% |
6% |
2% |
4% |
2% |
9% |
2% |
|
% patients with long-term opioid Rx (>90 days) |
19% |
6% |
16% |
6% |
15% |
6% |
25% |
5% |
To cite this abstract in AMA style:
Chen S, Feldman CH, Brill G, Lee YC, Desai RJ, Kim SC. Use of Prescription Opioids Among Patients with Systemic Inflammatory Diseases (SID) Versus Patients with Hypertension but No Sid [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/use-of-prescription-opioids-among-patients-with-systemic-inflammatory-diseases-sid-versus-patients-with-hypertension-but-no-sid/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-prescription-opioids-among-patients-with-systemic-inflammatory-diseases-sid-versus-patients-with-hypertension-but-no-sid/