Patients with new AS, PSA, RA Diagnosis Have High Reliance on Opioids

Patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) have a high reliance on opioids a year before and after their rheumatic disease diagnosis, according to a new study.¹

“These findings suggest that patients are still experiencing pain, and the peak in opioid use leading up to diagnosis suggests that this pain may be due to these diseases,” wrote investigators, led by Anna Sheahan, PhD, from UCB Pharma.

However, opioids are not recommended to treat rheumatic diseases. Rather, the United States treatment guidelines recommend conventional synthetic and biologic disease-modifying antirheumatic drugs (csDMARDS/bDMARDs) to ease the pain.

Although people might think opioids will make them feel better, they may do the opposite. Opioid use among patients with AS is linked to worse patient-reported outcomes, such as depression, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondylitis Functional Index. For patients with RA, opioid use is associated with reduced efficacy of csDMARDS and greater safety concerns. As a result, patients with RA who use opioids can delay the start of appropriate treatment.

Not only that, but opioid use is associated with heightened mortality rates, elevated healthcare expenses, increased dependency on family support, and diminished productivity.²

Investigators conducted a retrospective cohort study aiming to describe patient’s opioid usage in the year before and following a new diagnosis of AS (n = 5769), PsA (n = 10,880), and RA (n = 91,722), compared to controls without these diseases.¹ They leveraged US IBM MarketScan Commercial Claims and Encounters (CCAE) and Medicaid data to create 3 cohorts: incident cases of AS, PsA, or RA (2010 – 2017). Each patient was matched with 3 comparators who did not have incident disease based on birth year, sex, calendar year of index, region, and insurance plan type.

The team evaluated opioid use and appropriate treatment exposure according to US guideline recommendations in the 12-month baseline and follow-up periods using descriptive analyses. They assessed opioid use by frequency (total and quarterly) and cumulative duration (chronic and long-term). Long-term opioid use was defined as ≥ 1 opioid claim in ≥ 3 quarters, and chronic opioid use was considered a cumulative supply of ≥ 90 days in the studied period.

In the analysis, investigators also considered the comorbidities of depression, anxiety, fatigue, and fibromyalgia.

Overall, patients with an incident disease had a greater prevalence of opioid claims opioids than the comparators. Prevalence ratios for chronic opioid use in the follow-up were greater for patients with AS (3.82; 95% confidence interval [CI], 3.51 – 4.15), PsA (2.41; 95% CI, 2.25 – 2.58), and RA (3.22; 95% CI, 3.15 – 3.28), compared to comparators.

The prevalence ratios for long-term opioid use in the follow-up were also greater for AS (3.51; 95% CI, 3.25 – 3.79), PsA (2.25; 95% CI, 2.11 – 2.40), and RA (2.99; 95% CI, 2.94 – 3.05) than comparators.

A sub-analysis found opioid use in the follow-up was similar in females and males for AS and RA, but for PsA, females were more likely to receive opioids than males (40.4% vs 32.1%)

Investigators found 36.4% of patients with AS, 29.5% with PsA, and 44.4% with RA did not have any claim for guideline-appropriate therapy in follow-up. For those with Medicaid—which included 337 patients with AS, 530 with PsA, and 7369 with RA—30.6% of patients with AS, 36.6% with PsA, and 65.4% with RA did not have any claim for guideline-appropriate therapy in follow-up.

The results suggest patients with AS, PsA, or PsA have a high reliance on opioids around the time of diagnosis, and many people were not on appropriate treatment as defined by professional post-diagnosis guidelines.

“These findings indicate that opioid use for management of pain associated with AS, PsA, or RA is highly prevalent in the US and continues after diagnosis,” investigators concluded. “Reliance on opioids for pain management has been associated with substantial societal costs such as diversion, overdose, and addiction. Opioids are not recommended for chronic use, nor as treatment for inflammatory arthritides.”

References

1. ^{Sheahan A, Anjohrin S, Suruki R, Stark JL, Sloan VS. Opioid use surrounding diagnosis and follow-up in patients with ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis: Results from US claims databases. Clin Rheumatol. Published online April 25, 2024. doi:10.1007/s10067-024-06945-0}
2. ^{Beaulieu E, DiGennaro C, Stringfellow E, et al. Economic Evaluation in Opioid Modeling: Systematic Review. Value Health. 2021;24(2):158-173. doi:10.1016/j.jval.2020.07.013}