Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study

Abstract

Objective.To assess the prevalence of chronic opioid use in patients with ankylosing spondylitis (AS), and to compare the characteristics of patients with and without chronic opioid use.Methods.This was a retrospective cohort study of patients with AS identified in the Truven Health MarketScan Research database between January 1, 2012, and March 31, 2017. Commercial and Medicaid claims data were examined using both specific (720.0 and M45.x) and broader (720.x and M45.x) International Classification of Diseases (ICD) coding definitions. Patients were aged ≥ 18 years on the date of first qualifying ICD code occurrence (the index date). Demographics and clinical characteristics were assessed in the 12-month period preceding the index date. The 12-month followup period was used to assess prevalence and characteristics of chronic opioid use.Results.Chronic opioid use was common among patients with commercial claims (23.5% of ICD 720.0 patients; 27.3% of ICD 720.x patients), and especially those with Medicaid claims (57.1% and 76.7%, respectively). The proportion of patients with claims for anti–tumor necrosis factor therapies during followup was often low, and for Medicaid patients was lower among those with chronic opioid use (29.6% of ICD 720.0 patients; 2.3% of ICD 720.x patients) than those without (47.1% and 7.1%, respectively). Among chronic opioid users in all cohorts, the cumulative supply of opioids was typically high (≥ 270 days in the followup period); most opioids prescribed were Schedule II.Conclusion.Patients with AS receive opioids with disturbing frequency. The infrequent prescription of recommended therapies to these patients reflects a need to optimize treatment further through education of patients and healthcare professionals alike.

Use of prescription opioids among patients with rheumatic diseases compared to patients with hypertension in the USA: a retrospective cohort study

“…This study demonstrates that long-term prescription opioid use, as well as any opioid use, immediate-acting, extended-acting and > 3 types of opioid prescriptions were all highest among patients with AS. Long-term prescription opioid use was prevalent in 25% of patients with AS which is consistent with findings published in a recent study of 11 945 patients with AS identified by ICD-9 codes in Truven Marketscan commercial claims where 23.5% patients had chronic opioid use 32. One possible explanation for the high prevalence of long-term opioid use in AS is that chronic low back pain, which is associated with opioid prescription33–35, is more common among patients with AS and more debilitating than pain in other locations.…”

Application of machine learning in the diagnosis of axial spondyloarthritis

“…Patients often seek consultations with various types of healthcare providers in their journey toward diagnosis [25], undergoing expensive, unnecessary diagnostic workup and inappropriate medical interventions that may not directly improve patient outcomes [25,44,45 ▪ ] For example, an increase in opioid use was reported in patients with ankylosing spondylitis, representing a suboptimal treatment with economic ramifications to the health system [46]. Thus, a timely diagnosis of axSpA can yield substantial cost savings and increase resource efficiency among payers, physicians, and patients [47].…”

Variations in Long‐term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000‐2019)

“…One‐fifth of studies included only opioid‐naïve individuals (29 studies), mostly defined as the absence of opioid use in the 6 24,36,37,52,65,69–73 or 12 months 30,48,61,62,74–83 prior to the index date. Some studies investigated opioid use among patients with various specific health conditions: 43 studies 24,26–28,31,37,43,48,49,51,52,59,62,65,70,74,77–80,82–104 focused on noncancer pain, 14 studies 55,56,64,69,105–114 on musculoskeletal conditions, 13 studies 38–40,57,81,115–122 on injuries or trauma and eight studies 23,32,53,67,75,123–125 on infectious diseases. Seven studies 41,44,45,71,126–128 included patients with both cancer and noncancer pain, and six studies evaluated patients with cancer 60,129,130 or cancer survivors 61,131,132 .…”