Background/Purpose: In 2019, the American College of Rheumatology conditionally recommended tramadol for patients with hip and knee osteoarthritis (OA). While tramadol is known to be less prone to opioid use disorders, little is known about the degree to which the magnitude of these disorders differ among patients receiving tramadol relative to other non-tramadol opioids, and also the degree to which other opioid-related outcomes are lower among those receiving tramadol. The goal of this research is to compare the clinical burden of commercially-insured patients diagnosed with OA of the hip and/or knee among patients initiated on treatment with tramadol relative to those receiving non-tramadol opioids, using a large, national database in recent years.

Methods: The Optum Healthcare Solutions, Inc. data (1/2012-3/2017) were used to identify patients >18 years old with ≥2 diagnoses of hip and/or knee OA, and ≥90 days supply of tramadol or non-tramadol opioids during the three-year period from first prescription (index date) after their first OA diagnosis. Patients were required to be continuously-enrolled during the six months before (baseline) and 36 months after (follow-up) the index date. Selected clinical outcomes including rates of opioid use disorders, opioid dependence medications, constipation, fatigue, nausea, falls, and fractures. Patients in each cohort were matched 1:1 using a propensity score model accounting for baseline characteristics that included demographics, underlying comorbid conditions, medical resource use, and direct medical costs prior to initiation of treatment.

Results: Data for 14,491 patients were analyzed: 4,048 (28%) were initiated on tramadol, and 10,443 (72%) were initiated on non-tramadol opioids. After matching, 4,048 patients in each cohort were analyzed. Tramadol patients had elevated risk of opioid use disorders (1.2% of patients with opioid use disorder diagnoses), however risk of opioid use disorders was almost 3-fold higher in the non-tramadol cohort (4.2%) (p< 0.01). Consistent with those findings, rates of methadone and buprenorphine were also elevated in the non-tramadol cohort relative to the non-tramadol cohort (1.9% vs. 0.5% (p< 0.01); 3.2% vs. 1.4% (p< 0.01) respectively). Rates of other opioid-related outcomes were also lower, although quantitatively similar among the tramadol cohort vs. non-tramadol cohort, with rates of falls of 7.9% and 9.2% (p=0.03); fractures of 15.6% and 17.9% (p< 0.01); nausea of 17.4% and 20.0% (p< 0.01); fatigue of 33.5% and 37.1% (p< 0.01); and constipation of 12.9% and 15.0% (p< 0.01), respectively. Total 3-year healthcare costs of the tramadol cohort were lower than the non-tramadol cohort ($54,122 vs. $60,303 (p< 0.01), or avg. annual costs of $18,040 vs. $20,101).

Conclusion: This study reinforces that rates of opioid use disorders among OA patients initiated on tramadol are lower than those initiated on non-tramadol opioids; other negative events commonly associated with opioid treatment are lower but quantitatively similar among patients receiving tramadol and non-tramadol opioids.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-comparison-of-opioid-related-outcomes-among-commercially-insured-osteoarthritis-patients-treated-with-tramadol-vs-non-tramadol-opioids/