Rhudy Christian, Perry Courtney L, Singleton Michael, Talbert Jeffery, Barrett Terrence A
Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA.
Department of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA.
Aliment Pharmacol Ther. 2021 Mar;53(6):704-711. doi: 10.1111/apt.16269. Epub 2021 Jan 26.
Chronic opioid use is associated with poorer clinical outcomes in inflammatory bowel disease.
To investigate an association between chronic opioid use and persistence with biologic agents in management of inflammatory bowel disease.
A total of 16 624 patients diagnosed with inflammatory bowel disease and receiving a first-time biologic prescription from 2011 to 2016 were identified retrospectively from the Truven MarketScan Database. A cohort of 1768 patients were identified as chronic opioid users utilising outpatient prescription claims. Utilisation patterns of biologic therapies were assessed from inpatient administration and outpatient claims data, including persistence calculations. Information on healthcare utilisation and common comorbidities was also collected. A Cox regression model was constructed to assess the hazard of chronic opioid use on early discontinuation of biologic therapy controlling for disease severity.
A mean 1.5 different biologic agents were utilised by inflammatory bowel disease patients with chronic opioid use (vs 1.37 in the comparator group; P < 0.0001). A lower proportion of the chronic opioid use cohort persisted on biologic therapies to the end of the study period (16.2% vs 33.5% P < 0.0001). Inflammatory bowel disease patients with chronic opioid use utilised more healthcare resources and had a higher rate of comorbidities than the reference cohort. Patients with chronic opioid use were 23% more likely (hazard ratio 1.23; 95% CI [1.16-1.31]) to be non-persistent with biologic therapy while accounting for relevant markers of disease acuity.
Chronic opioid use is associated with increased hazard of biologic discontinuation in inflammatory bowel disease. Symptoms of opioid withdrawal may mimic IBD flares thereby leading providers to inappropriately switch biologic therapies and compromise disease control.
慢性阿片类药物的使用与炎症性肠病较差的临床结局相关。
研究慢性阿片类药物的使用与炎症性肠病治疗中生物制剂持续性之间的关联。
从Truven MarketScan数据库中回顾性识别出2011年至2016年期间共16624例诊断为炎症性肠病并接受首次生物制剂处方的患者。通过门诊处方索赔确定1768例患者为慢性阿片类药物使用者。从住院给药和门诊索赔数据评估生物治疗的使用模式，包括持续性计算。还收集了医疗保健利用情况和常见合并症的信息。构建Cox回归模型以评估慢性阿片类药物使用对控制疾病严重程度的生物治疗早期停药的风险。
使用慢性阿片类药物的炎症性肠病患者平均使用1.5种不同的生物制剂（对比组为1.37种；P<0.0001）。在研究期结束时，慢性阿片类药物使用队列中坚持生物治疗的比例较低（16.2%对33.5%，P<0.0001）。使用慢性阿片类药物的炎症性肠病患者比参照队列使用更多的医疗资源且合并症发生率更高。在考虑疾病严重程度的相关指标时，使用慢性阿片类药物的患者生物治疗不持续的可能性高23%（风险比1.23；95%可信区间[1.16 - 1.31]）。
慢性阿片类药物的使用与炎症性肠病中生物制剂停药风险增加相关。阿片类药物戒断症状可能模仿炎症性肠病发作，从而导致医疗人员不恰当地更换生物治疗并损害疾病控制。
