Journal article
Major adverse cardiovascular events and mortality with opioids versus NSAIDs initiation in patients with rheumatoid arthritis
Annals of the rheumatic diseases, Vol.82(11), pp.1487-1494
11/01/2023
DOI: 10.1136/ard-2023-224339
PMID: 37460169
Abstract
ObjectiveAssess major adverse cardiovascular event (MACE) risk with opioids compared with non-steroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA)MethodsWe conducted a new-user active comparator cohort study among patients with RA within FORWARD, The National Databank for Rheumatic Diseases, with ≥1 year participation between 1998 and 2021. Each opioid initiator was matched to two NSAID initiators by propensity scores (PSs). Patients were followed until the occurrence of the composite endpoint of MACE (myocardial infarction, stroke, heart failure, cardiovascular disease (CVD) death, venous thromboembolism (VTE)) and all-cause mortality. The risk of outcomes was estimated using Cox proportional hazards with adjustment for PS weights and imbalanced covariables.ResultsAmong 6866 opioid initiators and 13 689 NSAID initiators, 212 vs 253 MACE (20.6/1000 person-years (PY) vs 18.9/1000 PY) and 144 vs 150 deaths (13.5/1000 PY vs 10.8/1000 PY) occurred, respectively. The risk of MACE with opioids was similar to NSAIDs (HR=1.02, 95% CI 0.85 to 1.22), whereas all-cause mortality with opioids was 33% higher than NSAIDs (HR=1.33, 95% CI 1.06 to 1.67) in PS-weighted models. Among the individual outcomes of MACE, VTE risk tended to be higher in opioid initiators than NSAID initiators (HR=1.41, 95% CI 0.84 to 2.35). Strong opioids had a higher risk for all-cause mortality and VTE than weak opioids compared with NSAIDs suggesting a dose-dependent association.ConclusionOpioids had similar MACE risk compared with NSAIDs in patients with RA with increased all-cause mortality and likely VTE, which suggests that opioids are not safer than NSAIDs, as clinicians have perceived.
Details
- Title: Subtitle
- Major adverse cardiovascular events and mortality with opioids versus NSAIDs initiation in patients with rheumatoid arthritis
- Creators
- Gulsen Ozen - Center for RheumatologySofia Pedro - The National Databank for Rheumatic DiseasesKaleb Michaud - The National Databank for Rheumatic Diseases
- Resource Type
- Journal article
- Publication Details
- Annals of the rheumatic diseases, Vol.82(11), pp.1487-1494
- Publisher
- BMJ Publishing Group Ltd and European League Against Rheumatism
- DOI
- 10.1136/ard-2023-224339
- PMID
- 37460169
- ISSN
- 0003-4967
- eISSN
- 1468-2060
- Number of pages
- 8
- Grant note
- Resident Research Preceptorship Award / Rheumatology Research Foundation (http://dx.doi.org/10.13039/100006260)
- Language
- English
- Date published
- 11/01/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984702943202771
Metrics
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