ASSOCIATION BETWEEN CONCOMITANT SEDATIVE USE AT OPIOID INITIATION AND 30-DAY ACUTE RESPIRATORY AND HYPOXIC-ISCHEMIC HARM IN PATIENTS WITH CANCER: A RETROSPECTIVE COHORT STUDY USING KOREAN NATIONWIDE CLAIMS DATA
Author(s)
Aerang Hyeon, BSN1, Hae Sun Suh, MA, MS, PhD2.
1Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Korea, Republic of, 2College of Pharmacy, Kyung Hee University, Seoul, Korea, Republic of.
1Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Korea, Republic of, 2College of Pharmacy, Kyung Hee University, Seoul, Korea, Republic of.
OBJECTIVES: To examine whether concomitant sedative use (benzodiazepine or nonbenzodiazepine hypnotic) at opioid initiation is associated with 30-day acute respiratory and hypoxic-ischemic harm in patients with cancer.
METHODS: A retrospective cohort study was conducted using the Korean nationwide Health Insurance Review and Assessment (HIRA) database (2017-2024). Adults (≥18 years) with cancer who initiated opioids (no opioid prescription in the prior 365 days) were included; the first opioid prescription defined the index date. Patients were classified as having concomitant sedative use if a benzodiazepine or nonbenzodiazepine hypnotic prescription overlapped the index date, and as opioid alone otherwise. The primary outcome was a 30-day composite of acute respiratory and hypoxic-ischemic harm—opioid poisoning, respiratory failure or depression, hypoxemia or asphyxia, aspiration pneumonia, and hypoxic-ischemic brain injury—ascertained from inpatient and emergency diagnoses. Without propensity matching, multivariable Cox proportional hazards regression estimated crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for age, sex, individual comorbidities, metastatic disease, and baseline healthcare utilization; follow-up was censored at death.
RESULTS: A total of 19,730 patients were included (mean age 63.8 years; 52.9% male), of whom 8,962 (45.4%) had concomitant sedative use and 10,768 (54.6%) received opioid alone. Acute harm within 30 days occurred in 547 patients (2.77%), with 222 (2.48%) in the concomitant-use group and 325 (3.02%) in the opioid-alone group. Concomitant sedative use was associated with lower risk of 30-day acute harm, with little change after adjustment (crude HR 0.82, 95% CI 0.69-0.97; adjusted HR 0.81, 95% CI 0.69-0.97).
CONCLUSIONS: Despite concerns about additive respiratory depression, concomitant sedative use at opioid initiation was not associated with increased 30-day acute harm in patients with cancer. Further research is warranted to confirm these findings.
METHODS: A retrospective cohort study was conducted using the Korean nationwide Health Insurance Review and Assessment (HIRA) database (2017-2024). Adults (≥18 years) with cancer who initiated opioids (no opioid prescription in the prior 365 days) were included; the first opioid prescription defined the index date. Patients were classified as having concomitant sedative use if a benzodiazepine or nonbenzodiazepine hypnotic prescription overlapped the index date, and as opioid alone otherwise. The primary outcome was a 30-day composite of acute respiratory and hypoxic-ischemic harm—opioid poisoning, respiratory failure or depression, hypoxemia or asphyxia, aspiration pneumonia, and hypoxic-ischemic brain injury—ascertained from inpatient and emergency diagnoses. Without propensity matching, multivariable Cox proportional hazards regression estimated crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for age, sex, individual comorbidities, metastatic disease, and baseline healthcare utilization; follow-up was censored at death.
RESULTS: A total of 19,730 patients were included (mean age 63.8 years; 52.9% male), of whom 8,962 (45.4%) had concomitant sedative use and 10,768 (54.6%) received opioid alone. Acute harm within 30 days occurred in 547 patients (2.77%), with 222 (2.48%) in the concomitant-use group and 325 (3.02%) in the opioid-alone group. Concomitant sedative use was associated with lower risk of 30-day acute harm, with little change after adjustment (crude HR 0.82, 95% CI 0.69-0.97; adjusted HR 0.81, 95% CI 0.69-0.97).
CONCLUSIONS: Despite concerns about additive respiratory depression, concomitant sedative use at opioid initiation was not associated with increased 30-day acute harm in patients with cancer. Further research is warranted to confirm these findings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH235
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Oncology, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)