Opioid Utilization in Rheumatoid Arthritis: Changes in Opioid Use after Advanced Therapy Initiation and Its Moderators

Speaker(s)

Huang Y1, Bazzazzadehgan S2, Ghodke O2, Lin LY1, Bruera S3, Ramachandran S4, Bhattacharya K5, Bentley J4, Yang Y2
1Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA, 2Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, University, MS, USA, 3Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA, 4Department of Pharmacy Administration and Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA, 5Department of Pharmacy Administration and Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University, MS, USA

Presentation Documents

OBJECTIVES: Opioid use is common for pain management among rheumatoid arthritis (RA) patients. However, opioid utilization patterns are not well-established especially after advanced therapy initiation with tumor necrosis factor inhibitors (TNFi), non-TNFi biologics, and Janus kinase inhibitors (JAKi). This study examined changes in opioid use before and after advanced therapy initiation.

METHODS: Older (≥65 years) Medicare beneficiaries with advanced therapy initiation (first prescription=index date) who had at least one RA diagnosis were identified from 2012-2020 5% national Medicare claims data. A new-user design was utilized. Eligible beneficiaries included those with continuous part A, B, D, but not part C enrollment, during 12 months pre- and post-index period. Primary outcomes were changes from pre- to post-index period in any opioid use and chronic opioid use (defined as 90-day cumulative days supply). McNemar tests evaluated whether opioid use changed after advanced therapy initiation. Additionally, conditional logistic regression was used to assess effect modification of the change in any and chronic opioid use by demographic and clinical factors.

RESULTS: A cohort of 3,810 beneficiaries was identified with a mean age (SD) of 73.16 (5.95) years, female (76.25%), White (85.38%), residing in the southern region (43.72%), and high Charlson comorbidity index scores (55.98%). Compared to pre-index period, any opioid use decreased in the post-index period (OR=0.87; 95%CI=0.77-0.98); chronic opioid use increased (OR=1.40; 95%CI=1.15-1.71). These effects were modified by clinical factors (any opioid use: psoriasis, number of pain conditions, back pain, and use of NSAIDs, COX-2 inhibitors, and glucocorticoids; chronic opioid use: ankylosing spondylitis and use of NSAIDs).

CONCLUSIONS: The results suggest that after advanced therapy initiation, while use of any opioid decreased, chronic opioid use increased among Medicare beneficiaries with RA. Future studies are needed to assess comparative effectiveness of each advanced therapy in affecting utilization patterns of opioids in RA.

Code

HSD128

Disease

Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)