Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan (Dr. As-Sanie).
AbbVie Inc, Chicago, Illinois (Dr. Soliman).
J Minim Invasive Gynecol. 2021 Feb;28(2):297-306.e2. doi: 10.1016/j.jmig.2020.05.029. Epub 2020 Jun 9.
To determine the prevalence and pattern of opioid use in endometriosis and the characteristics of patients prescribed an opioid using medical insurance claims data.
We performed a retrospective cohort analysis of data from the Truven MarketScan Commercial database for the period of January 1, 2011 to December 31, 2016.
The Truven database includes inpatient, outpatient, and prescription claims covering more than 115 million unique individuals and over 36 million inpatient hospital discharges across multiple payer types and all 50 states.
Women with endometriosis were defined as those with 1 inpatient or 2 outpatient codes for endometriosis.
No interventions were assigned. Women who filled an opioid prescription within 12 months of diagnosis were placed in the opioid cohort and women who did not fill an opioid prescription were placed in the nonopioid cohort.
Baseline characteristics were evaluated 12 months preindex (date of the first diagnosis) and opioid use was assessed for 12 months after the index date. The dataset included 58 472 women with endometriosis. Of these, 61.7% filled an opioid prescription during the study period. More than 95% filled prescriptions for short-acting opioids (SAOs) only, 4.1% filled prescriptions for both SAOs and extended-release/long-acting opioids (LAOs), and 0.6% filled prescriptions for LAOs only. Patients who filled an opioid prescription had higher baseline comorbidities (especially gynecologic and chronic pain comorbidities) and endometriosis-related medication use compared with patients who did not fill an opioid prescription during the study period. Patients who filled both LAO and SAO prescriptions had the highest total days' supply of opioids, the proportion of days covered by prescriptions, and morphine equivalent daily dose. These patients also had the highest proportions of opioid switching and dose augmentation. Statistical trends in data were not substantially altered when analyses excluded patients with chronic pain comorbidities or surgical opioid prescriptions.
Although opioids are not a recommended treatment for endometriosis, more than half of our cohort filled an opioid prescription within 1 year after a first recorded diagnosis of endometriosis. Patients who filled an opioid prescription tended to use more endometriosis-related medications and have a higher comorbidity burden. Additional research is necessary to better understand the reasons and outcomes associated with opioid utilization in endometriosis and to determine if there is a more effective pain management treatment plan for patients taking opioids.
确定在子宫内膜异位症中阿片类药物的使用情况和模式，以及使用医疗保险索赔数据开处阿片类药物的患者的特征。
我们对 2011 年 1 月 1 日至 2016 年 12 月 31 日期间 Truven MarketScan 商业数据库中的数据进行了回顾性队列分析。
Truven 数据库涵盖了超过 1.15 亿个独特个体和超过 3600 万住院患者出院的门诊、住院和处方索赔，涵盖了多种支付类型和所有 50 个州。
患有子宫内膜异位症的女性定义为有 1 个住院或 2 个门诊代码诊断为子宫内膜异位症的患者。
未进行任何干预。在诊断后 12 个月内开处阿片类药物处方的女性被纳入阿片类药物队列，而在研究期间未开处阿片类药物处方的女性被纳入非阿片类药物队列。
基线特征在指数日期（首次诊断日期）前 12 个月进行评估，在指数日期后 12 个月内评估阿片类药物的使用情况。该数据集包括 58472 名患有子宫内膜异位症的女性。其中，61.7%的患者在研究期间开处了阿片类药物处方。超过 95%的患者开的是短效阿片类药物（SAO）处方，4.1%的患者开的是 SAO 和延长释放/长效阿片类药物（LAO）处方，0.6%的患者开的是 LAO 处方。与在研究期间未开处阿片类药物处方的患者相比，开处阿片类药物处方的患者有更高的基线合并症（尤其是妇科和慢性疼痛合并症）和与子宫内膜异位症相关的药物使用情况。开 LAO 和 SAO 处方的患者的阿片类药物总供应天数、处方覆盖率和吗啡等效日剂量最高。这些患者的阿片类药物转换和剂量增加比例也最高。当分析排除了患有慢性疼痛合并症或手术阿片类药物处方的患者时，数据中的统计趋势并没有实质性改变。
尽管阿片类药物不是子宫内膜异位症的推荐治疗方法，但我们的队列中仍有一半以上的患者在首次记录子宫内膜异位症诊断后 1 年内开处了阿片类药物处方。开处阿片类药物处方的患者往往使用更多的与子宫内膜异位症相关的药物，并且合并症负担更高。需要进一步研究以更好地了解与子宫内膜异位症中阿片类药物使用相关的原因和结果，并确定是否有更有效的针对服用阿片类药物的患者的疼痛管理治疗方案。
