The Effect of Early Tumor Necrosis Factor Inhibitor Initiation on Chronic Opioid Use in Individuals with Axial Spondylarthritis.

Objective: Opioid use remains common despite effective therapies for axial spondyloarthritis (axSpA). We assessed whether early tumor necrosis factor inhibitor (TNFi) use is associated with reduced risk of chronic opioid use.

Methods: Using the Merative^TM MarketScan® Commercial Database containing health insurance billing claims data, we conducted a time-stratified, propensity score (PS)-matched cohort study of adults 18-65 years with axSpA. Early TNFi exposure was defined using pharmacy and medical claims as any incident TNFi use within 6 months of axSpA diagnosis. We used propensity scores to match early TNFi users 1:1 to those not starting TNFi within 6 months, in 1-year cohort accrual blocks. We compared risk of chronic opioid use (≥90 days' prescription) among early TNFi users versus comparators using Cox proportional hazard models, overall and stratified by prior opioid use (within 12 months).

Results: We included 8,508 individuals with axSpA after PS-matching (4,254 early TNFi initiators and 4,254 comparators) with mean age 42 years and 50% were female. Chronic opioid use occurred in 20.9% (22.3% early TNFi initiators and 19.6% comparators). Early TNFi initiators had 17% higher risk of chronic opioid use versus matched comparators (95% CI 1.06-1.28), with higher risk of chronic opioid use for early TNFi initiators in the opioid-naïve but not opioid-experienced stratum (HR 1.96, 95% CI 1.41-2.74 vs HR 1.06, 95% CI 0.96-1.17).

Conclusion: Early TNFi initiation was not associated with reduced risk of chronic opioid use versus later or no TNFi initiation. Confounding by indication in administrative claims data limit result interpretation.