Prescription Opioid Use in Patients With and Without Systemic Lupus Erythematosus — Michigan Lupus Epidemiology and Surveillance Program, 2014–2015

Somers, Emily C.; Lee, Jiha; Hassett, Afton L.; Zick, Suzanna M.; Harlow, Sioḃán D.; Helmick, Charles G.; Barbour, Kamil E.; Gordon, Caroline; Brummett, Chad M.; Minhas, Deeba; Padda, Amrita; Wang, Lu; McCune, W. Joseph; Marder, Wendy

doi:10.15585/mmwr.mm6838a2

Cited by 22 publications

(18 citation statements)

References 9 publications

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“…US claims data show comparable medication use, frequent inpatient admissions and physician visits leading to high costs in the first postdiagnosis year. 17 Even if in Germany opioids are not prescribed as commonly as in the USA, where every third patient with SLE received opioids, 18 the frequency of prescription remains problematic. In addition, other analgesics, NSAIDs and antidepressants are also frequently prescribed.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

et al. 2021

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ObjectiveTo analyse comorbidity and healthcare utilisation in individuals with SLE.MethodsA cohort of individuals with incident SLE diagnosis in 2016 were investigated using claims data from a German statutory health insurance fund. Concomitant diagnoses, medical prescriptions, hospitalisation and sick leave were analysed in the year prior to diagnosis and during a 3-year follow-up in comparison with age-matched and sex-matched controls (1) without autoimmune diseases and (2) with incident diabetes mellitus. Sensitivity analyses were performed excluding cases with additional autoimmune diagnoses and without prescription of antimalarials.ResultsAmong 571 individuals with SLE, hypertension (48%), depression (30%), hyperlipidaemia (25%), osteoarthritis (25%) and osteoporosis (20%) were the most frequent comorbidities in 2016. Cerebrovascular disease was documented in 9.6%. The number of drugs (mean 9.6, ∆+6.2), hospitalisation (40%, ∆+27%) and days on sick leave (median 46 days, ∆+27 days) increased significantly in the first year with SLE diagnosis. Individuals with SLE were more frequently hospitalised and had more medications compared with both control groups (all p<0.001). The increase in comorbidity diagnoses was low in controls without autoimmune diseases, while controls with diabetes showed a more pronounced increase in cardiovascular risk factors, but less in osteoporosis and cerebrovascular disease. Sensitivity analyses showed comparable results.ConclusionComorbidities are frequently detected at the time of diagnosis of SLE. High numbers of drug prescriptions and hospitalisation following SLE diagnosis reflect the comprehensive disease burden. The comparison with incident diabetes shows that differences with controls without autoimmune disease are overestimated by detection bias.

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Section: Discussionmentioning

confidence: 99%

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

et al. 2021

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“…Stronger analgesics, such as opioids, may have a role in the management of pain related to SLE; in fact, data from a recent survey showed 31% of patients with SLE reported current use of prescription opioids. 18 However, there is a lack of evidence to support long-term use of opioids among patients with rheumatic diseases, so ideally treatment with such agents is limited to short-term use, as other anti-inflammatory and/or immunosuppressive therapies are able to take effect. 19 The first objective of this study was to describe the utilisation of five common drug classes (antimalarials, prescription NSAIDs, corticosteroids, immunosuppressants and biologics) among patients with SLE using administrative claims data, with a focus on oral corticosteroid dosing and the extent of opioid use.…”

Section: Key Messagesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

Birt

Griffing

et al. 2020

Lupus Sci Med

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ObjectivesTo investigate corticosteroid and opioid use among patients with SLE and to examine the impact of belimumab initiation on the use of other SLE therapies.MethodsWe identified adult patients with SLE (International Classification of Diseases, 9th Revision/10th Revision 710.0 and M32) between 1 January 2012 and 31 May 2018 (earliest SLE diagnosis=index date) within MarketScan administrative claims data. Patients were followed from index date for a minimum of 12 months and until the earlier of disenrolment in their health plan or study end (31 May 2018). Corticosteroid utilisation, corticosteroid dose (in prednisone equivalents) and opioid utilisation (overall, by strength (weak, strong) and by duration (chronic use defined as >90 days of cumulative drug supply)) were measured during follow-up. Oral corticosteroid and opioid use were compared in the 6 months before and after initiation of belimumab.ResultsThere were 49 413 patients with SLE eligible for analysis (mean (SD) age: 50.1 (14.0) years, 90.2% female). Of these, 68.5% received corticosteroids, and the average number of prescriptions was 4.59 (4.11) over the first 12 months of follow-up. Among patients with oral corticosteroids, average daily dose was 19.4 (14.2) mg and 59.6% had an average daily dose of ≥15 mg. Half (52.6%) had at least one opioid prescription and of these, 34.6% had chronic use over the first 12 months of follow-up. Among patients initiating belimumab during follow-up (n=1710), oral corticosteroid use decreased by 9.1% (p=0.001), and average daily dose decreased from 14.5 (18.4) mg to 11.9 (18.0) mg (p<0.001) in the 6 months after initiation compared with the 6 months prior. Initiation of belimumab had no impact on prevalence of opioid use.ConclusionsA high proportion of patients with SLE are treated with corticosteroids to control SLE and opioid therapy to manage chronic pain. While there was no change in opioid use, oral corticosteroid use and dose intensity decreased following initiation of belimumab.

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“…Patients with SLE are more likely to receive longterm opioid prescriptions compared to patients without the rheumatic disease [28][29]. Retrospective analysis from the Truven MarketScan ].…”

Section: Prevalence Of Opioid Use In Sle (Table 1)mentioning

confidence: 99%

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

Anastasiou

Yazdany

2022

Current Opinion in Rheumatology

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Purpose of reviewThis article discusses publications assessing the prevalence, efficacy, and safety of opioid analgesics in patients with rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, and systemic sclerosis. Recent findingsRecent studies show long-term opioid use is common in patients with inflammatory rheumatic disease. We did not find any studies demonstrating improved function or pain control with long-term opioid use in people with rheumatic diseases. Some data shows potential adverse effects including increased risk for fractures and opioid poisoning hospitalizations. There is evidence demonstrating an association of opioid use with mental health disorders, fibromyalgia, obesity, and disability, although causative links have not been established. Only minimal reductions in opioid use were observed after initiation of biologic disease modifying antirheumatic drugs (DMARDs). Studies have shown delayed DMARD initiation and reduced DMARD use in patients on opioids, raising concerns that these analgesics may delay care or initially mask symptoms of active disease.

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Prescription Opioid Use in Patients With and Without Systemic Lupus Erythematosus — Michigan Lupus Epidemiology and Surveillance Program, 2014–2015

Cited by 22 publications

References 9 publications

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

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

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