Co-prescription of Gabapentinoids and Opioids in Osteoarthritis in the UK

Sarfaroj Khan 

Disclosures

November 12, 2020

Takeaway

  • Patients with a diagnosis of osteoarthritis (OA) are at an increased risk of gabapentinoid prescription in the UK.

  • After being prescribed a gabapentinoid, patients with OA are at an increased risk of recurrent gabapentinoid-opioid co-prescription.

Why this matters

  • Findings highlight the need for risk-restriction strategies in OA, including improved access to effective non-pharmacological and surgical management.

Study design

  • This study used data from the UK Clinical Practice Research Datalink database to estimate the relative incidence of a first gabapentinoid prescription in a 1:1 matched cohort of patients (age, >40 years) with and without OA (n=215,357).

  • Incident gabapentinoid users in both cohorts were followed to estimate and compare the event rate of gabapentinoid-opioid co-prescription.

  • Funding: None.

Key results

  • The relative incidence of the first gabapentinoid prescription was almost 3-fold higher in patients with OA vs matched control participants (incidence rate ratio, 2.93; 95% CI, 2.87-3.00).

  • Among incident gabapentinoid users, the rate of gabapentinoid-opioid co-prescription event in OA (n=27,374; median follow-up, 3.9 years) and non-OA cohorts (n=9262) was 4.03 (95% CI, 4.02-4.05) and 2.03 (95% CI, 2.30-2.33) events per year, respectively.

  • The rate of gabapentinoid-opioid co-prescription was higher in patients with OA defined as long-term gabapentinoid users (6.24 [95% CI, 6.22-6.26]).

  • The higher rate of co-prescription events in the OA cohort persisted but was attenuated after adjusting for covariates (adjusted rate ratio for co-prescription with any opioid, 1.29; 95% CI, 1.28-1.30).

  • This increased risk was seen across age, sex, geographic regions and calendar years when restricted to strong opioids and to long-term gabapentinoid users and when co-prescription was defined as within 14 days and same-day prescribing.

Limitations

  • Results are based on prescriptions issued rather than dispensed or medications taken.

 

Yu D, Appleyard T, Cottrell E, Peat G. Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology (Oxford). 2020 Nov 7 [Epub ahead of print]. doi: 10.1093/rheumatology/keaa586. PMID: 33159800 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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