Pain Medication and Corticosteroid Use in Ankylosing Spondylitis, Psoriatic Arthritis, and Rheumatoid Arthritis in the United States: A Retrospective Observational Study

Abstract

Objective: We compared pain medication use in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) versus matched control over 2 years; a subgroup analysis assessed changes in pain medication use in patients who initiated a biologic during 12 months before and after. Methods: This was a retrospective observational cohort study using an administrative claims database. Newly diagnosed adult patients with AS, PsA, or RA identified between 1/1/2014 and 7/31/2017 were included. Demographics, baseline characteristics, and pain medication use were described using descriptive statistics. Differences in pain medication use were assessed using McNemar's/Wilcoxon signed-rank test for categorical/continuous variables. Results:The study included 2180 AS, 5681 PsA, and 34,047 RA patients to assess overall pain medication use over 2 years; 188 AS, 921 PsA, and 1599 RA patients were included to assess changes in pain medication use 12 months before and after initiation of biologic. Demographics and baseline characteristics were balanced. In the overall cohort, 74.6% AS, 75.0% PsA, and 83.0% RA patients used any pain medication at baseline versus matched control; pain medications use 2 years after diagnosis date was reported in 73.5% AS, 74.1% PsA, and 81.3% RA patients. Among AS, PsA, and RA patients, use of prescribed NSAIDs (AS: 68.1 vs.

Review of publications evaluating opioid use in patients with inflammatory rheumatic disease

“…Chronic opioids are prescribed to 17% to 67% of US patients with RA. The highest recent estimate is from a study of Social Security Disability Insurance beneficiaries less than 65 years of age (Table 1) [6 ▪ –8 ▪ ,9 ▪▪ ,10–14]. A cross-sectional study of the National Ambulatory Medical Care Survey examining data from 2011 to 2016 showed that one-fourth of US office visits for RA involved an opioid prescription; opioid prescribing for outpatient RA visits increased from 15% to 34% ( P < 0.0001) over the time frame; and primary care physicians were the most common prescribers [6 ▪ ].…”

“…Furthermore, different studies have shown that opioid use only modestly decreased after initiation of biologic therapies (Table 2). The most recent publication on this topic found that although opioid use significantly decreased 12 months after RA patients initiated biologic medications, the overall prevalence of opioid use remained high at 40% [9 ▪▪ ]. It is unknown whether these patients use opioids after biologic initiation because of persistent inflammatory disease activity not sufficiently controlled on therapy, persistent pain not due to active RA, patient reluctance to stop opioids, or lack of physician initiative to taper opioids after initiating biologic therapy.…”

“…Psoriatic arthritis patients taking a tumor necrosis factor inhibitor (TNFi) or antiinterleukin (IL)-12/23 inhibitor have frequently (17%) been prescribed opioid medications [36]. Moreover, Hunter and colleagues showed that opioid use only decreased a small amount (38.1% vs. 33.8%, P = 0.013) after biologic initiation in an analysis of 2013–2019 claims data [9 ▪▪ ].…”

“…Despite a lack of evidence, opioid use is common among patients with AS with an estimated prevalence of 19–57% (Table 1) [39–41]. In a recent retrospective analysis, opioid use only slightly decreased without statistical significance in the 12 months after biologic initiation (42.6 vs. 36.2%, not significant) [9 ▪▪ ].…”

Nonsteroidal anti-inflammatory drugs and cardiovascular disease risk in spondyloarthritis-spectrum diseases

“…There are recent studies from different regions of the world revealing the real-world usage of NSAIDs in SpA. In a retrospective, observational study representing nationwide administrative claims data from the USA which included 2180 patients with AS and 5681 patients with PsA, at diagnosis NSAIDs were prescribed in 43.0% of patients with AS and 39.0% of patients in PsA, both significantly higher than matched controls [18]. Another study evaluated the primary care analgesia prescribing in English National Health Service-managed patients with inflammatory arthritis [19].…”