开始使用阿片类药物的轴性脊柱关节炎或银屑病关节炎患者长期使用阿片类药物的相关因素。

IF 4.7 2区医学 Q1 RHEUMATOLOGY

Rheumatology Pub Date : 2025-04-01 DOI:10.1093/rheumatology/keae444

Yun-Ting Huang, David A Jenkins, Belay Birlie Yimer, Meghna Jani

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引用次数: 0

摘要

目标：新开始使用阿片类药物的轴性脊柱关节炎（AxSpA）或银屑病关节炎（PsA）患者中，多达五分之一的患者会在第一年内转为长期使用阿片类药物。本研究旨在调查与 AxSpA/PsA 阿片类药物新使用者长期使用阿片类药物相关的个体因素：2006-2021年间开始使用阿片类药物的患有AxSpA/PsA且未罹患癌症的成人患者被纳入英国国家初级保健数据库Clinical Practice Research Datalink Gold。长期使用阿片类药物的定义是：在随访的第一年中，90天内开具的阿片类药物处方≥3张，或阿片类药物供应量≥90天。评估的个体因素包括社会人口学因素、生活方式因素、药物使用和合并症。采用带有患者水平随机截距的混合效应逻辑回归模型来研究个体特征与长期使用阿片类药物几率之间的关系：共从8212名患者（3037名AxSpA患者；5175名PsA患者）中发现了10300例开始使用阿片类药物的病例。以下因素与长期使用阿片类药物有关：目前吸烟（OR：1.62；95%CI：1.38,1.90）、药物使用障碍（OR：2.34，95%CI：1.05,5.21）、自杀/自残史（OR：1.84；95%CI：1.13,2.99）、并存纤维肌痛（OR：1.62；95%CI：1.11,2.37），较高的Charlson合并症指数（OR：3.61；95%CI：1.69,7.71为高分），开始时高MME/天（OR：1.03；95%CI：1.02,1.03）和加巴喷丁胺（OR：2.35；95%CI：1.75,3.16）和抗抑郁药的使用（OR：1.69；95%CI：1.45,1.98）：对于需要止痛的 AxSpA/PsA 患者，了解与长期使用阿片类药物风险较高相关的生活方式、社会人口学和处方特点，可以及时采取干预措施，如结构化用药审查和戒烟，以促进更安全的处方和更好的患者预后。

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Factors associated with long-term opioid use among patients with axial spondyloarthritis or psoriatic arthritis who initiate opioids.

Objective: Up to one in five patients with axial spondyloarthritis (AxSpA) or psoriatic arthritis (PsA) newly initiated on opioids transition to long-term use within the first year. This study aimed to investigate individual factors associated with long-term opioid use among opioid new users with AxSpA/PsA.

Methods: Adult patients with AxSpA/PsA and without prior cancer who initiated opioids between 2006 and 2021 were included from Clinical Practice Research Datalink Gold, a national UK primary care database. Long-term opioid use was defined as having ≥3 opioid prescriptions issued within 90 days, or ≥90 days of opioid supply, in the first year of follow-up. Individual factors assessed included sociodemographic, lifestyle factors, medication use and comorbidities. A mixed-effects logistic regression model with patient-level random intercept was used to examine the association of individual characteristics with the odds of long-term opioid use.

Results: In total, 10 300 opioid initiations were identified from 8212 patients (3037 AxSpA; 5175 PsA). The following factors were associated with long-term opioid use: being a current smoker (OR: 1.62; 95%CI: 1.38,1.90), substance use disorder (OR: 2.34, 95%CI: 1.05,5.21), history of suicide/self-harm (OR: 1.84; 95%CI: 1.13,2.99), co-existing fibromyalgia (OR: 1.62; 95%CI: 1.11,2.37), higher Charlson Comorbidity Index (OR: 3.61; 95%CI: 1.69,7.71 for high scores), high MME/day at initiation (OR: 1.03; 95%CI: 1.02,1.03) and gabapentinoid (OR: 2.35; 95%CI: 1.75,3.16) and antidepressant use (OR: 1.69; 95%CI: 1.45,1.98).

Conclusions: In AxSpA/PsA patients requiring pain relief, awareness of lifestyle, sociodemographic and prescribing characteristics associated with higher risk of long-term opioid use can prompt timely interventions such as structured medication reviews and smoking cessation to promote safer prescribing and better patient outcomes.

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来源期刊

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.