Prescription of analgesics in patients with rheumatic diseases in Germany

Albrecht, Katinka; Marschall, Ursula; Callhoff, Johanna

doi:10.1007/s00393-021-00971-y

Cited by 11 publications

(7 citation statements)

References 30 publications

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“…21 Recently, a study from Germany derived from an insurance database reported that 8.8% of patients had a long-term prescription for opioids (defined as a prescription in ≥3 consecutive quarters). 22 This is lower than our estimates (10%), but in general, the German population has a lower use of opioids than the US population, and their cases were identified based on diagnosis codes, which may risk misclassification. 5,23 Among patients with SLE, we found that those who had serositis (pleural/pericardial effusion) and in particular acute pericarditis were more likely to be on LTOT.…”

Section: Discussioncontrasting

confidence: 61%

Long-Term Opioid Therapy Among Patients With Systemic Lupus Erythematosus in the Community: A Lupus Midwest Network (LUMEN) Study

et al. 2022

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ObjectiveThere is little information about the epidemiology and factors associated with opioid therapy in systemic lupus erythematosus (SLE). We aimed to assess the prevalence of opioid therapy and explore factors associated with long-term opioid therapy (LTOT) in patients with SLE.MethodsPatients with SLE were matched with non-SLE controls in a population-based cohort on January 1, 2015. We captured demographics, manifestations of lupus, comorbidities (fibromyalgia, mood disorders, osteoarthritis, chronic low back pain [CLBP], chronic kidney disease, avascular necrosis, osteoporosis, fragility fractures, and cancer), and the area deprivation index (ADI). Opioid prescription data were used to assess prevalence of LTOT, defined as contiguous prescriptions (gaps of <30 days between prescriptions) and receiving opioid therapy ≥90 days or ≥10 prescriptions before index date.Results465 SLE patients and 465 non-SLE controls were included; 13% of SLE patients and 3% of non-SLE controls were receiving opioid therapy (P<0.001), and 11% of SLE patients were on LTOT versus 1% of non-SLE controls. Among SLE patients, acute pericarditis (OR: 3.92; 95% CI: 1.78-8.66), fibromyalgia (OR: 7.78; 95% CI: 3.89-15.55), fragility fractures (OR: 3.72; 95% CI: 1.25-11.07), CLBP (OR: 4.00; 95% CI: 2.13-7.51), and mood disorders (OR: 2.76; 95% CI: 1.47-5.16) were associated with LTOT. We did not find an association between opioid therapy and ADI.ConclusionPatients with SLE have higher LTOT than controls. Among patients with SLE, LTOT was associated with pericarditis and several comorbidities. However, LTOT was not associated with kidney disease despite the limited pain control options in these patients.

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Section: Discussioncontrasting

confidence: 61%

Long-Term Opioid Therapy Among Patients With Systemic Lupus Erythematosus in the Community: A Lupus Midwest Network (LUMEN) Study

et al. 2022

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“…A claims data analysis using the Institute for Applied Health Research (InGef) database estimated a prevalence of ICD-10-GM M45 diagnosis of 0.32% in 2013, which was used to extrapolate the number of adults with AS in Germany to 217,400 [ 10 ]. The proportion of 0.31% with an M45 diagnosis in 2020 was comparable in a BARMER claims data analysis, which was, however, not primarily aimed at estimating prevalence [ 27 ]. Whether the ICD-10-GM M45 diagnosis covers all persons with AS remains uncertain.…”

Section: Resultsmentioning

confidence: 99%

Systematisches Review zur Schätzung der Prävalenz entzündlich-rheumatischer Erkrankungen in Deutschland – Englische Version

et al. 2023

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Objective This study aimed to update the prevalence estimates of inflammatory rheumatic diseases (IRD) in Germany. Methods A systematic literature search in PubMed and Web of Science (last search 08 November 2022) identified original articles (regional and nationwide surveys and claims data analyses for arthritides, connective tissue diseases, and vasculitides) on prevalences for the period 2014–2022. Data sources, collection period, case definition, and risk of bias are reported. Prevalences were estimated from available national data, with consideration of international data. Results Screening by two authors yielded 263 hits, of which 18 claims data analyses and 2 surveys met the inclusion criteria. Prevalences ranged from 0.42 to 1.85% (rheumatoid arthritis), 0.32–0.5% (ankylosing spondylitis), 0.11–0.32% (psoriatic arthritis), 0.037–0.14% (systemic lupus erythematosus), 0.07–0.77% (Sjögren’s disease/sicca syndrome), 0.14–0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04–0.05% (giant cell arteritis, ≥ 50 years), and 0.015–0.026% (ANCA-associated vasculitis). The risk of bias was moderate in 13 and high in 7 studies. Based on the results, we estimate the prevalence of IRD in Germany to be 2.2–3.0%, which corresponds to approximately 1.5–2.1 million affected individuals. The prevalence of juvenile idiopathic arthritis was reported to be around 0.10% (0.07–0.10%) of 0–18-year-olds, corresponding to about 14,000 children and adolescents in Germany. Conclusion This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on claims data analyses. In the absence of multistage population studies, the available data are, overall, uncertain sources for prevalence estimates, with a moderate to high risk of bias.

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“…We lack this information in our cohort studies. The use of painkillers and comorbidity are underestimated when only considering data from rheumatology care 33…”

Section: Discussionmentioning

confidence: 99%

Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020

et al. 2023

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ObjectiveTo investigate prevalence, incidence and medication of interstitial lung disease (ILD) among German individuals with rheumatoid arthritis (RA).MethodsNationwide BARMER claims data from 2007 to 2020 were used. RA-ILD was identified by diagnosis codes, prescription of disease-modifying antirheumatic drugs (DMARDs) and lung diagnostics. ILD was assigned as incident or prevalent relative to the year of the first diagnosis. We identified prescriptions of glucocorticoids, conventional synthetic (cs), biological (b) and targeted synthetic (ts)DMARDs, antifibrotics and rheumatology and/or pulmonology care.ResultsAmong all persons with RA (40 686 in 2007 to 85 175 in 2020), 1.7%–2.2%/year had ILD with a slight decline since 2013. Incident ILD was 0.13%–0.21% per year and remained stable over time. ILD was more common in seropositive RA, in men and in the elderly (mean age 72 years in 2020). Glucocorticoids (84% to 68%), csDMARD (83% to 55%) and non-steroidal anti-inflammatory drug use (62% to 38%) declined, while bDMARDs (16% to 24%) rose. In 2020, 7% received tsDMARDs, 3% antifibrotics, 44% analgesics and 30% opioids. DMARD therapy was more common if a rheumatologist was involved and antifibrotics if a pulmonologist was involved. Opioid use was highest if no specialist was involved (39%) but also common in rheumatology care (32%) and less frequent in pulmonology care (21%).ConclusionsRA-ILD is rare and mainly affects elderly persons. No trend in incidence was observed but treatment strategies have enlarged. Specialist care is necessary to provide disease-specific therapies. The continuing high analgesic and opioid demand shows unmet needs in these patients.

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Prescription of analgesics in patients with rheumatic diseases in Germany

Cited by 11 publications

References 30 publications

Long-Term Opioid Therapy Among Patients With Systemic Lupus Erythematosus in the Community: A Lupus Midwest Network (LUMEN) Study

Long-Term Opioid Therapy Among Patients With Systemic Lupus Erythematosus in the Community: A Lupus Midwest Network (LUMEN) Study

Systematisches Review zur Schätzung der Prävalenz entzündlich-rheumatischer Erkrankungen in Deutschland – Englische Version

Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020

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