在开始使用短效阿片类药物制剂后 1 年的随访中，慢性非癌痛患者的阿片类药物治疗轨迹。
Opioid therapy trajectories of patients with chronic non-cancer pain over 1 year of follow-up after initiation of short-acting opioid formulations.
机构信息
Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
出版信息
Pain Med. 2024 Mar 1;25(3):173-186. doi: 10.1093/pm/pnad169.
OBJECTIVE
This study compared opioid utilization trajectories of persons initiating tramadol, short-acting hydrocodone, or short-acting oxycodone, and it characterized opioid dose trajectories and type of opioid in persistent opioid therapy subsamples.
METHODS
A retrospective cohort study of adults with chronic non-cancer pain who were initiating opioid therapy was conducted with the IQVIA PharMetrics® Plus for Academics data (2008-2018). Continuous enrollment was required for 6 months before ("baseline") and 12 months after ("follow-up") the first opioid prescription ("index date"). Opioid therapy measures were assessed every 7 days over follow-up. Group-based trajectory modeling (GBTM) was used to identify trajectories for any opioid and total morphine milligram equivalent measures, and longitudinal latent class analysis was used for opioid therapy type.
RESULTS
A total of 40 276 tramadol, 141 023 hydrocodone, and 45 221 oxycodone initiators were included. GBTM on any opioid therapy identified 3 latent trajectories: early discontinuers (tramadol 39.0%, hydrocodone 54.1%, oxycodone 61.4%), late discontinuers (tramadol 37.9%, hydrocodone 39.4%, oxycodone 33.3%), and persistent therapy (tramadol 6.7%, hydrocodone 6.5%, oxycodone 5.3%). An additional fourth trajectory, intermittent therapy (tramadol 16.4%), was identified for tramadol initiators. Of those on persistent therapy, 2687 individuals were on persistent therapy with tramadol, 9169 with hydrocodone, and 2377 with oxycodone. GBTM on opioid dose resulted in 6 similar trajectory groups in each persistent therapy group. Longitudinal latent class analysis on opioid therapy type identified 6 latent classes for tramadol and oxycodone and 7 classes for hydrocodone.
CONCLUSION
Opioid therapy patterns meaningfully differed by the initial opioid prescribed, notably the presence of intermittent therapy among tramadol initiators and higher morphine milligram equivalents and prescribing of long-acting opioids among oxycodone initiators.
目的
本研究比较了曲马多、短效氢可酮和短效羟考酮使用者的阿片类药物使用轨迹，并在持续性阿片类药物治疗亚组中描述了阿片类药物剂量轨迹和阿片类药物类型。
方法
这项回顾性队列研究纳入了使用 IQVIA PharMetrics® Plus for Academics 数据（2008-2018 年）的慢性非癌痛成年患者。要求患者在首次开具阿片类药物处方（“索引日期”）前 6 个月（“基线期”）和之后 12 个月（“随访期”）连续入组。在随访期间，每 7 天评估一次阿片类药物治疗措施。使用基于群组的轨迹建模（GBTM）来识别任何阿片类药物和总吗啡毫克当量测量值的轨迹，使用纵向潜在类别分析来确定阿片类药物治疗类型。
结果
共纳入 40276 例曲马多、141023 例氢可酮和 45221 例羟考酮使用者。GBTM 分析任何阿片类药物治疗发现了 3 种潜在轨迹：早期停药者（曲马多 39.0%，氢可酮 54.1%，羟考酮 61.4%）、晚期停药者（曲马多 37.9%，氢可酮 39.4%，羟考酮 33.3%）和持续性治疗者（曲马多 6.7%，氢可酮 6.5%，羟考酮 5.3%）。对于曲马多使用者，还确定了第四种轨迹，即间歇性治疗（曲马多 16.4%）。在持续性治疗者中，2687 例患者持续使用曲马多治疗，9169 例患者持续使用氢可酮治疗，2377 例患者持续使用羟考酮治疗。在每个持续性治疗组中，阿片类药物剂量的 GBTM 产生了 6 个相似的轨迹组。阿片类药物治疗类型的纵向潜在类别分析确定了曲马多和羟考酮的 6 个潜在类别，氢可酮的 7 个类别。
结论
初始阿片类药物的选择显著影响阿片类药物治疗模式，特别是曲马多使用者中存在间歇性治疗，以及羟考酮使用者中阿片类药物剂量更高和使用长效阿片类药物。
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