Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
Clin Gastroenterol Hepatol. 2018 Apr;16(4):534-541.e6. doi: 10.1016/j.cgh.2017.10.022. Epub 2017 Nov 26.
BACKGROUND & AIMS: The prescription of opiate medications is increasing. Individuals with inflammatory bowel diseases (IBD) can develop serious complications from opiate use, but few data are available on the prescription of these drugs to patients with IBD. We examined trends in prescriptions of opiates and their association with all-cause mortality in individuals with IBD.
We performed a retrospective cohort study of 3517 individuals with Crohn's disease (CD) and 5349 with ulcerative colitis (UC) using the primary care database ResearchOne, which holds de-identified clinical and administrative information from the health records of approximately 6 million persons (more than 10% of the total population) in England. We explored trends in prescriptions of all opiates, codeine, tramadol, or strong opiates, separately from 1990 through September 14, 2014. Associations between opiates and all-cause mortality were examined using propensity score-matched analysis.
There was a statistically significant increase in the prescription of opiate medications, with 10% of subjects receiving an opiate prescription from 1990 through 1993 compared to 30% from 2010 through 2013 (chi-square for trend, P < .005). Prescription of strong opiates was significantly associated with increased premature mortality of patients with CD (heavy use) or UC (moderate or heavy use). There was a significant association between heavy use of any opiate or codeine alone and premature mortality of patients with UC. Use of tramadol alone, or in combination with codeine, was not associated with premature mortality in patients with CD or UC.
In an analysis of primary care patients with IBD in England, we found prescriptions for opiate drugs to have increased significantly from 1990 through 2013. Heavy use of strong opiates among patients with IBD associates with increased all-cause premature mortality.
阿片类药物的处方量正在增加。患有炎症性肠病（IBD）的个体可能会因使用阿片类药物而产生严重的并发症，但有关这些药物在 IBD 患者中的处方数据却很少。我们研究了阿片类药物处方的趋势及其与 IBD 患者全因死亡率的关系。
我们使用初级保健数据库 ResearchOne 对 3517 例克罗恩病（CD）患者和 5349 例溃疡性结肠炎（UC）患者进行了回顾性队列研究，该数据库包含来自英格兰约 600 万人（超过总人口的 10%）的匿名临床和行政信息。我们分别从 1990 年至 2014 年 9 月 14 日探索了所有阿片类药物、可待因、曲马多或强阿片类药物处方的趋势。使用倾向评分匹配分析来研究阿片类药物与全因死亡率之间的关系。
阿片类药物处方明显增加，1990 年至 1993 年有 10%的患者接受阿片类药物处方，而 2010 年至 2013 年有 30%（趋势卡方检验，P<0.005）。CD 患者（重度使用）或 UC 患者（中度或重度使用）强阿片类药物处方与过早死亡显著相关。单独使用任何阿片类药物或可待因，或与可待因联合使用，与 UC 患者的过早死亡显著相关。单独使用曲马多，或与可待因联合使用，与 CD 或 UC 患者的过早死亡无关。
在对英格兰 IBD 初级保健患者的分析中，我们发现 1990 年至 2013 年期间阿片类药物的处方量显著增加。IBD 患者强阿片类药物的大量使用与全因过早死亡相关。
