Changing Trends in Opioid Use Among Patients With Rheumatoid Arthritis in the United States

Abstract

In the US, opioid use in older patients with RA peaked in 2010 and is now declining slightly. Withdrawal of propoxyphene from the US market in 2010 had minimal effect on overall opioid use, because use of propoxyphene was replaced by increased use of other opioids.

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

“…The majority of studies were from USA ( n = 28) , followed by UK ( n = 4 studies) , Spain ( n = 3 studies) and Canada ( n = 3 studies) , with single studies from Norway , Denmark , Australia and India . There were no studies that compared data from multiple countries.…”

Serious Infections in Rheumatoid Arthritis Offspring Exposed to Tumor Necrosis Factor Inhibitors

“…In addition, we used case definitions for RA and serious infections that have been shown to be valid in prior studies . Moreover, our data source (i.e., MarketScan) has been extensively used for the conduct of pharmacoepidemiologic studies in rheumatic diseases, particularly related to biologic DMARDs (such as TNFi) and RA outcomes . Furthermore, administrative database studies like ours are less prone to selection bias or recall bias compared to drug or pregnancy registries, which might differentially select drug‐exposed subjects based on certain characteristics and/or outcomes or collect exposure information after the outcome has occurred .…”

“…In addition, we used case definitions for RA and serious infections that have been shown to be valid in prior studies (12,14). Moreover, our data source (i.e., MarketScan) has been extensively used for the conduct of pharmacoepidemiologic studies in rheumatic diseases, particularly related to biologic DMARDs (such as TNFi) and RA outcomes (16)(17)(18)(19). 0.0 (0.0, 20.9) Etanercept (n = 195) 3.6 (1.6, 7.6) Golimumab (n = 10) 0.0 (0.0, 34.5) Infliximab (n = 37) 8.1 (2.1, 23.0) * TNFi = tumor necrosis factor inhibitor; RA = rheumatoid arthritis; 95% CI = 95% confidence interval.…”

Interrupted Time Series Needed to Analyze Effects of Propoxyphene Withdrawal From Market and Health Outcome Trend Estimates: Comment on the Article by Curtis et al

“…We read with great interest the report by Curtis et al , describing their study which examined time trends of opioid use among older adults with rheumatoid arthritis (RA) in the US. We believe some additional methodologic and health policy considerations are necessary.…”

“…An ITS model can then be applied to estimate the average annual percentage change in opioid prescriptions as an effect of propoxyphene market withdrawal (which occurred November 19, 2010) using 3 time stages: before the market withdrawal (2006–2010), during the market withdrawal (2011, because opioid use was observed in 12‐month intervals), and after the market withdrawal (2012–2014) . If overdisbursement is observed in the preliminary results, a log‐link function and maximum likelihood function can be added to adjust the final ITS regression model . Therefore, an ITS analysis can better characterize the impact of propoxyphene withdrawal on opioid use.…”