加巴喷丁类药物使用与长期阿片类药物使用者基于索赔的虚弱变化之间的关联。

Association Between Gabapentinoid Use and Changes in Claims-Based Frailty Among Long-Term Opioid Users.

作者信息

Westra Jordan, Raji Mukaila, Baillargeon Jacques, Aparasu Rajender R, Kuo Yong-Fang

机构信息

Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.

Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.

出版信息

Drugs Aging. 2025 Jun 18. doi: 10.1007/s40266-025-01216-2.

DOI:10.1007/s40266-025-01216-2

PMID:40531287

Abstract

OBJECTIVE: Assess the association of opioids and gabapentinoids with changes in frailty among Medicare beneficiaries who used opioids for 90 or more consecutive days. METHODS: Using a Medicare sample between 2014 and 2020, this study included long-term opioid users who were eligible for Medicare parts A, B, and D for 3 years and had no prior gabapentinoid use. The study was broken into three 1-year periods: lookback, exposure, and outcome. The exposure of interest was gabapentinoid and opioid use measured in period 2. The primary outcome was difference in frailty between periods 1 and 3. Linear regression was used to assess the difference in frailty change by gabapentinoid and opioid use. Multinomial regression was also used to assess the odds of categorical frailty change by gabapentinoid and opioid use. RESULTS: Overall, the changes in frailty between assessment periods were small. Those who had no continued opioid/no gabapentinoid use showed decreases in frailty (- 0.0005), while each of the other three groups increased in frailty between the assessment periods (opioids only, 0.0040; gabapentinoids only, 0.0136; opioids + gabapentinoids, 0.0142). In addition, each of the drug groups showed increased odds for large increases in frailty compared with those who had no continued opioid/no gabapentinoid use (opioids only, odds ratio (OR): 1.25, 95% confidence interval (CI) 1.04-1.49; gabapentinoids only, OR: 3.12, 95% CI 1.75-5.55; opioids + gabapentinoids, OR: 2.30, 95% CI 1.85-2.87). CONCLUSIONS: Using gabapentinoids, opioids, or a combination of the two showed greater increases in frailty compared with those who used neither drug after long-term opioid use.

摘要

目的：评估在连续90天或更长时间使用阿片类药物的医疗保险受益人中，阿片类药物和加巴喷丁类药物与虚弱变化之间的关联。方法：利用2014年至2020年的医疗保险样本，本研究纳入了符合医疗保险A、B和D部分资格3年且此前未使用过加巴喷丁类药物的长期阿片类药物使用者。该研究分为三个1年时间段：回顾期、暴露期和结果期。感兴趣的暴露因素是在第2阶段测量的加巴喷丁类药物和阿片类药物的使用情况。主要结果是第1阶段和第3阶段之间虚弱程度的差异。采用线性回归评估加巴喷丁类药物和阿片类药物使用导致的虚弱变化差异。多项回归也用于评估加巴喷丁类药物和阿片类药物使用导致的分类虚弱变化的几率。结果：总体而言，评估期之间的虚弱变化很小。那些没有持续使用阿片类药物/未使用加巴喷丁类药物的人虚弱程度有所下降（-0.0005），而其他三组在评估期之间虚弱程度均有所增加（仅使用阿片类药物组，0.0040；仅使用加巴喷丁类药物组，0.0136；阿片类药物+加巴喷丁类药物组，0.0142）。此外，与那些没有持续使用阿片类药物/未使用加巴喷丁类药物的人相比，每个药物组出现大幅虚弱增加的几率都更高（仅使用阿片类药物组，比值比（OR）：1.25，95%置信区间（CI）1.04-1.49；仅使用加巴喷丁类药物组，OR：3.12，95%CI 1.75-5.55；阿片类药物+加巴喷丁类药物组，OR：2.30，95%CI 1.85-2.87）。结论：与长期使用阿片类药物后既不使用加巴喷丁类药物也不使用阿片类药物的人相比，使用加巴喷丁类药物、阿片类药物或两者联合使用会使虚弱程度增加得更多。