Prevalence Of Chronic Opioid Use Among Those With Ankylosing Spondylitis

September 2019

A retroactive cohort study was conducted to determine the prevalence of chronic opioid use among those with ankylosing spondylitis, and study the relationships between opioid use and AS comorbidities and complications.

Methodology:

Researchers reviewed patient diagnostic and prescription data from the Truven Health MarketScan® Research Database between January 1, 2012 and March 31, 2017. Data was analyzed and comparisons were made among two groups: adults diagnosed with ankylosing spondylitis (AS) who were chronically prescribed opioid medications, and adults with AS who were not prescribed opioid medications, with the goal of identifying characteristic differences among the two groups.

Patient data was retrieved using specific International Classification of Diseases (ICD) codes for ankylosing spondylitis diagnosis. Data was further categorized and compared between two claim types: Commercial insurance claims and Medicaid claims.

Findings:

The study found that chronic opioid use was highest in AS patients with Medicaid claims (57.1% of ICD 720.0¹, and 76.7% of 720.x² patients), with commercial claims having a lower incidence of chronic opioid use (23.5% and 27.3%, respectively). Additionally, TNF inhibitor usage was reported to be low overall, and for Medicaid patients TNF inhibitor usage was lower in those with chronic opioid use (29.6% and 2.3% respectively), than in those who did not use chronic opioids (with 47.1% and 7.1% of these patients receiving TNF inhibitor treatment).

Claims data also demonstrated that the supply of opioids prescribed to patients was typically high (greater than 270 days) in both Medicaid and commercial claims. Additionally, opioid users reported to have more depression (48% more) and anxiety (28% more), than non-opioid users.

Conclusion and Discussion:

The data showed that up to 50% of AS patients did not fill an anti-inflammatory (NSAID) nor TNF inhibitor prescription before filling a Schedule II opioid prescription. The study raises concerns regarding a lack of adherence to the ACR/SAA/SPARTAN guidelines to treat ankylosing spondylitis and non-radiographic axial spondyloarthritis, which were updated in August of 2019. The authors noted that opioids do not treat the underlying inflammation in AS, like NSAIDs and TNF inhibitors do, and thus raise concerns that many with AS are not receiving appropriate treatment.

ICD CODES, as defined by the Centers for Disease Control and Prevention: