Opioid Use High in Ankylosing Spondylitis Despite Treatment Guidelines

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There is a pressing need to identify barriers to optimizing ankylosing spondylitis therapy within the treatment guidelines.

Despite current treatment guidelines, patients with ankylosing spondylitis (AS) receive prescription opioids at a “disturbing” frequency, according to research published in Journal of Rheumatology.

Researchers conducted a retrospective cohort study of patients with AS to examine the use of opioids in this population. Patient and claims data were identified through the Truven Health MarketScan database between January 2012 and March 2017. All claims were categorized either as Commercial or Medicaid claims.

Both specific and broad International Classification of Diseases (ICD) codes were used to examine the claims (720.0 and M45.x or 720.x and M45.x, respectively). The key objective of the study was an estimation of chronic opioid use in the patient population over a 12-month period.

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Among patients in the Commercial cohort, 23.5% of ICD 720.0 patients and 27.3% of ICD 720.x patients had chronic opioid use. More than half of patients in the Medicaid cohort had chronic opioid use (57.1% of ICD 720.0 patients and 76.7% of ICD 720.x patients). In both cohorts, depression and anxiety were common.

In the commercial cohort, claims for anti-tumor necrosis factor (TNF) therapies, disease-modifying antirheumatic drugs, and nonsteroidal anti-inflammatory drugs were similar regardless of whether the patient had chronic opioid use; however, claims for prescribed muscle relaxants and oral corticosteroids were more frequent among those with chronic opioid use (54.4% vs 20.2% and 18.4% vs 9.6%, respectively).

In the Medicare group, these claims were comparable, although fewer patients had claims for anti-TNF therapies (29.6% vs 47.1%) and more had claims for muscle relaxants (61.5% vs 33.3%). Most prescribed opioids were schedule II drugs, and in both groups, patients’ cumulative opioid supply was ≥270 days (61.6% vs 70.2% in the commercial and Medicare groups, respectively).

Despite current treatment guidelines indicating that nonsteroidal anti-inflammatory drugs, followed by anti-TNF therapies, should be the first line of pharmacotherapy, prescription opioids may offer “inexpensive and rapid means of achieving symptomatic relief” for patients with AS. A “substantial proportion” of patients in all cohorts had claims for prescription opioids, particularly among the Medicare population. Additionally, researchers noted that few Medicaid patients had a rheumatologist listed as their provider type, which may suggest that primary care physicians are not familiar with current AS treatment guidelines.

Study limitations included variables in coding definitions, limitations in claims data, and the possible inclusion of patients with false positives. The researchers were also limited by the use of databases as their primary information source and a lack of records indicating over-the-counter NSAID use.

Despite these limitations, the researchers of the study concluded that “[t]he high proportion of chronic opioid users…indicates that the issue is both frequent and enduring.” They added that “[t]here is a pressing need to identify barriers to optimizing AS therapy within the treatment guidelines, to further define the circumstances that underlie chronic opioid usage, and to educate patients and practitioners on more appropriate therapies for the disease.”

Disclosure: This study was funded by UCB Pharma. All authors are employees of UCB Pharma..


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