Chronic Opioid Use High Among Patients With Ankylosing Spondylitis

Chronic opioid use was common among patients with ankylosing spondylitis (AS), according to cohort study data published in The Journal of Rheumatology.

Commercial and Medicaid claims data from patients with AS were abstracted from the Truven MarketScan database between January 01, 2012, and March 31, 2017. Qualifying claims were identified according to AS diagnostic codes of the 9th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). Both specific (720.0 and M45.x) and broader (720.x and M45.x) ICD codes were used. Eligible patients were ≥18 years on the date of first qualifying ICD code occurrence and had either ≥2 claims with qualifying ICD-9 codes given >7 days apart by any physician, or ≥1 claim with the diagnosis code by a rheumatologist in an outpatient setting. Demographic and clinical characteristics were assessed in the 12-month period preceding the index date, and the 12-month period following the index date was used to capture opioid use patterns.

Study data were captured for 4 distinct cohorts: the 720.0 commercial claims cohort (n=11,945), the 720.x commercial claims cohort (n=79,190), the 720.0 Medicaid claims cohort (n=917), and the 720.x Medicaid claims cohort (n=14,041). Chronic opioid use was common both among patients with commercial claims (23.5% of 720.0 patients vs 27.3% of 720.x patients) and patients with Medicaid claims (57.1% and 76.7%, respectively). During follow-up, the number of claims for anti-tumor necrosis (TNF) factor drugs was lower among Medicaid patients with chronic opioid use (29.6% of 720.0 patients vs 2.3% of 720.x patients) compared with Medicaid patients without chronic opioid use (47.1% and 7.1%, respectively). The cumulative supply of opioids was ≥270 days for the majority of patients with chronic use (61.6%), and most prescribed opioids were schedule II.

These data underscore both the frequency of opioid use among patients with AS and the chronic underuse of recommended therapies, including anti-TNFs. To optimize treatment for AS, further education on chronic opioid use for providers and patients alike should be implemented. 

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Reference

Sloan VS, Sheahan A, Stark JL, Suruki RY. Opioid use in patients with ankylosing spondylitis is common in the United States: outcomes of a retrospective cohort study [published online January 15, 2019]. J Rheumatol. doi: 10.3899/jrheum.180972