Opioid Use in Patients with Ankylosing Spondylitis Is Common in the United States: Outcomes of a Retrospective Cohort Study

• Published in: Journal of rheumatology 2019-11, Vol.46 (11), p.1450-1457
• Main Authors: Sloan, Victor S, Sheahan, Anna, Stark, Jeffrey L, Suruki, Robert Y
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analgesics, Opioid - therapeutic use; Female; Follow-Up Studies; Humans; Male; Medicaid; Middle Aged; Prescription Drug Misuse; Prevalence; Retrospective Studies; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - epidemiology; Treatment Outcome; United States - epidemiology; Young Adult
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.180972

To assess the prevalence of chronic opioid use in patients with ankylosing spondylitis (AS), and to compare the characteristics of patients with and without chronic opioid use. This was a retrospective cohort study of patients with AS identified in the Truven Health MarketScan Research database between January 1, 2012, and March 31, 2017. Commercial and Medicaid claims data were examined using both specific (720.0 and M45.x) and broader (720.x and M45.x) International Classification of Diseases (ICD) coding definitions. Patients were aged ≥ 18 years on the date of first qualifying ICD code occurrence (the index date). Demographics and clinical characteristics were assessed in the 12-month period preceding the index date. The 12-month followup period was used to assess prevalence and characteristics of chronic opioid use. Chronic opioid use was common among patients with commercial claims (23.5% of ICD 720.0 patients; 27.3% of ICD 720.x patients), and especially those with Medicaid claims (57.1% and 76.7%, respectively). The proportion of patients with claims for anti-tumor necrosis factor therapies during followup was often low, and for Medicaid patients was lower among those with chronic opioid use (29.6% of ICD 720.0 patients; 2.3% of ICD 720.x patients) than those without (47.1% and 7.1%, respectively). Among chronic opioid users in all cohorts, the cumulative supply of opioids was typically high (≥ 270 days in the followup period); most opioids prescribed were Schedule II. Patients with AS receive opioids with disturbing frequency. The infrequent prescription of recommended therapies to these patients reflects a need to optimize treatment further through education of patients and healthcare professionals alike.