Opioid use does not decline after pa- tients with inflammatory arthritis tart tumour necrosis factor (TNF) inhibitor therapy; in fact, averageuse appears to increase, according tofindings from a study presented at thecongress.
“Starting a TNF inhibitor, you wouldthink the pain would go down, and wewere hoping the dose of opioids wouldgo down with it,” said investigator Dr.
Olafur Palsson from the University ofIceland in Reykjavik and Lund Universityin Sweden.
“But this research shows that the insertion of a TNF inhibitor has only a minoreffect on that,” he said in an interview.
The findings are an “important remind-
er” to rheumatologists that they should
broaden their consideration of other pain
treatments and techniques for patients
with inflammatory arthritis, Dr. Palsson
said. “They should focus on trying other
tactics to get patients’ pain and stiffness
under control; there may be some underly-
ing factors.”
The investigators compared opioid
prescription rates in 940 patients with
rheumatoid arthritis, psoriatic arthritis,
ankylosing spondylitis, and undifferentiat-
ed arthritis with a control group of 4,700
matched subjects.
The team assessed nationwide databases that capture all patients taking biologics for rheumatic diseases and more than90% of all drug prescriptions. They foundthat patients with inflammatory arthritis inIceland were more likely to have receivedat least one opioid prescription than werecontrol subjects (75% vs. 43%).
During the study period, average yearly opioid dose rose much more in thepatient group than in the control group.
And 2 years after the initiation of TNF
Overall, the patient group was pre-
scribed nearly six times more opioids than
the control group. The investigators used a
bootstrapping analysis to obtain a reliable
confidence interval.
“In a way, the data are extremelyskewed,” Dr. Palsson explained. “Most patients were taking very low doses of opioids and a few were taking extremely highdoses. It’s hard to do a statistical analysis.
“With bootstrapping, you don’t detectsmall fluctuations in data,” he said, acknowledging this study limitation. Also,“prescription data don’t necessarily reflectconsumption of a drug. People prescribedhigh doses may not necessarily be consuming high doses.”
Dr. Palsson has disclosed no relevantfinancial relationships.
TNF inhibitors don’t quell opioid use for
inflammatory arthritis
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