Research Identifies Risk Factors for Long-Term Opioid Use in Patients With PsA, AxSpA

Yun-Ting Huang, PhD, MS

Credit: Linkedin

New research has elucidated factors associated with long-term opioid use in patients with axial spondyloarthritis (AxSpA) or psoriatic arthritis (PsA), including substance use disorder and a history of suicide or self-harm.¹

“[The] higher frequency [of long-term opiod use] in AxSpA and PsA highlights the complexity of pain management in this patient cohort and the importance of optimizing opioid therapy to reduce the risk of long-term use and associated harms²,” lead investigator Yun-Ting Huang, PhD, MS, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, and Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, United Kingdom, and colleagues wrote.¹ “Most research investigating risk factors associated with long-term opioid use is restricted to post-surgical populations using US administrative data. The evidence on the patients with AxSpA/ PsA is scarce.”

Huang and colleagues analyzed data from 10,300 opioid initiations from 8212 patients (AxSpA, 3037; PsA, 5175) with AxSpA/PsA and without prior cancer between 2006–2021 from Clinical Practice Research Datalink Gold, a national United Kingdom primary care database. Participants had similar mean ages between AxSpA (mean, 49.0; standard deviation [SD], 14.8) and PsA (mean, 50.4; SD, 14.1) although females made up more of the PsA cohort (52.1%) than the AxSpA cohort (29.5%). Sulfasalazine (11.7%), leflunomide (3.2%), and methotrexate (24.3%) prescriptions were more common in patients with PsA. Around 20% of both cohorts were prescribed antidepressants. More patients with PsA were obese (24.6%) and morbidly obese (4.5%) compared with those with AxSpA (16.5% and 1.6%, respectively). More patients in the AxSpA cohort smoked (26.1%) than in the PsA cohort (20.0%).¹

The investigators found that being a current smoker (odds ratio [OR], 1.62 [95%CI, 1.38-1.90]), substance use disorder (OR, 2.34 [95%CI, 1.05-5.21]), history of suicide/self-harm (OR, 1.84 [95%CI, 1.13-2.99]), co-existing fibromyalgia (OR, 1.62 [95%CI, 1.11-2.37]), higher Charlson Comorbidity Index (OR, 3.61 [95%CI, 1.69-7.71] for high scores), high morphine milligram equivalent/day at initiation (OR, 1.03 [95%CI, 1.02-1.03]) and gabapentinoid (OR, 2.35 [95%CI, 1.75-3.16]) and antidepressant use (OR, 1.69 [95%CI, 1.45-1.98]) were associated with long-term opioid use.¹

They also found that after comprehensive adjustment, socioeconomic deprivation was associated with an incrementally higher risk of long-term opioid use. In comparison with the least deprived quintile, the most deprived area (5th quintile) was associated with a doubling of risk (OR, 2.27 [95% CI, 1.61-3.19]), the 4th quintile with an 85% increase (OR, 1.85 [95% CI, 1.34-2.55]), and the 3rd quintile with a 63% increase (OR, 1.63 [95% CI, 1.19-2.23]).¹

On the other hand, being female (OR=0.83, 95% CI=0.74, 0.95), taking benzodiazepines (OR=0.79, 95% CI=0.63, 0.98), and being mixed or non-white ethnicity (OR=0.55, 95% CI=0.37, 0.82) was associated with a reduced risk of long-term opioid use. The lower risk in females and patients taking benzodiazepine was only seen in patients with PsA.¹

“Awareness of one or more of these patient factors can prompt tailored approaches for pain management in practice, including non-pharmacological treatments, smoking cessation services, and structured medication reviews. This study highlights the importance of a comprehensive assessment, from health conditions and medication profiles to lifestyle habits for AxSpA/PsA, to help personalize treatment approaches and then promote safer prescribing and improve longterm patient outcomes,” Huang and colleagues wrote.¹

REFERENCES

1. Huang YT, Jenkins DA, Yimer BB, Jani M. Factors associated with long-term opioid use among patients with axial spondyloarthritis or psoriatic arthritis who initiated opioids. Rheumatol. Published online August 16, 2024; keae444.doi: 10.1093/rheumatology/keae444
2. Albrecht K, Marschall U, Callhoff J. Prescription of analgesics in patients with rheumatic diseases in Germany : A claims data analysis. Verordnung von Schmerzmitteln bei Patienten mit rheumatischen Erkrankungen in Deutschland : Eine Analyse von Abrechnungsdaten. Englische Version. Z Rheumatol. 2021;80(Suppl 2):68-75. doi:10.1007/s00393-021-00971-y