Pharmacoepidemiology
Opioid and other analgesic use in older adults initiating a biologic disease-modifying therapy for treatment of autoimmune diseases Meghan Cupp* Meghan Cupp Andrew R Zullo Nina Joyce Francesca Beaudoin Arman Oganisian
Background
Autoimmune diseases cause significant pain, particularly in older adults, who experience high rates of opioid use amid unclear pain management guidelines. Biologic disease-modifying therapies (bDMTs) are expected to alleviate pain and reduce analgesic use, but this remains empirically unverified. This study assesses changes in opioid and other analgesic use in older adults initiating a bDMT for autoimmune disease.
Methods
This retrospective, longitudinal descriptive study included community dwelling US Medicare beneficiaries aged >65 years who initiated a bDMT for treatment of rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus (SLE), ulcerative colitis or Crohn’s disease in 2008-2019. We estimated analgesic use incidence in the 12 months pre- and 24 months post-initiation of a bDMT. Risk of analgesic use in the first and second years post-initiation versus pre-initiation were analyzed using a generalized estimating equation model. Subgroup analyses were conducted by sex, condition, and bDMT initiation prior to 2015.
Results
Among 1,061,463 eligible individuals, 22,671 initiated a bDMT during the study period. Opioids were the most used analgesic, surpassed only by corticosteroid use which was considered as an indicator of symptom severity. The incidence of opioid and other analgesic use increased steadily in the 12 months prior to initiation and remained high throughout the subsequent 24 months of follow-up (see Figure). Opioid use rose post-initiation in the overall cohort (RRyear1 1.04 [95%CL 1.03, 1.06]; RRyear2 1.05 [95%CL 1.03, 1.07]) and only SLE patients had a decrease (RRyear1 0.86 [95%CL 0.76, 0.98]; RRyear2 0.83 [95%CL 0.67, 1.04]).
Conclusion
In all conditions but SLE, opioid and other analgesic use increased after initiation of a bDMT, underscoring the need for careful consideration of pain management strategies in this population. Future research should assess the dynamic between pain, bDMT use, and pain management strategies.
