Patients with osteoarthritis treated with tramadol had a 20%-50% high- er risk of dying during the first year of treatment than did patients whowere treated with NSAIDs, according to theresults of a large, population-based studyperformed in British Columbia, Canada.
Within 1 year of starting treatment, 296of 13,798 patients treated with tramadolhad died, compared with 246 of 13,798treated with naproxen, giving a death rateof 21.5 versus 17. 8 per 1,000 person-years,and representing a 20% increase in all-cause mortality versus the NSAID (hazardratio, 1. 2).
Similar results were seen comparingtramadol with diclofenac and tramadolwith cyclooxygenase (COX)- 2 inhibitors,but with increasing death rates of 24.8versus 19. 5 per 1,000 person-years (hazardratio, 1. 3) and 23.6 versus 15. 7 per 1,000person-years (HR, 1. 5), respectively.
However, all-cause mortality was lowerwith tramadol than with the opiate painkiller codeine (21.5 vs. 25.5 per 1,000 person-years; HR, 0.8), Lingyi Li, a PhD studentfrom the University of British Columbia, Vancouver, reported at the congress.
This is not the first time that tramadol’s excess mortality risk has beenhighlighted. Indeed, just last year (JAMA.2019;321[ 10]:969-82), researchers usingThe Health Improvement Network database reported found that tramadol wasassociated with higher all-cause mortalitythan two COX- 2 inhibitors, celecoxib (31.2versus 18. 4 per 1,000 person-years) andetoricoxib (25.7 versus 12. 8 per 1,000person-years).
Ms. Li and associates’ data not onlynow add further weight to those findings,but also go a step further by looking atother serious risks associated with tramadol’s use among patients with OA.
“The objective of this study is to comparetramadol with other commonly prescribedpain-relief medications on the risk of several severe outcomes, including mortality,cardiovascular diseases [CVD], venousthromboembolism [V TE], and hip fracture,”she said during her virtual presentation.
Using sequential propensity scorematching, the researchers compared dataon patients in British Columbia during2005-2014 with a first prescription of tramadol (n = 56,325), the NSAIDs naproxen( 13,798) or diclofenac ( 17,675), COX- 2 inhibitors ( 17,039), or codeine ( 7,813).
“For CVD, we found that there is a higherrisk among tramadol users, compared withdiclofenac [HR, 1. 2] and COX- 2 inhibitors [HR,1. 2], but not with naproxen [HR, 1.0] and codeine [HR, 0.9] users,” Ms. Li reported.
Similarly, the 1-year risk of V TE wassignificantly higher among tramadol users
Tramadol’s mortality risk in osteoarthritis
could outweigh its benefits
Continued on page 12
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