Table 2 Key observational studies reporting analgesic prescribing levels or predictors in patients with RA
From: Pharmacological pain management in patients with rheumatoid arthritis: a narrative literature review
Authors | Year | Analgesics considered | Region | Size | Study aim | Key Findings |
|---|---|---|---|---|---|---|
Baker et al. [84] | 2021 | Opioids | North America | 37,868 | Evaluate if incident chronic opioid use higher in patients with obesity | • 27% using opioids at baseline • Severe obesity associated with higher risk of chronic opioid use (HR 1.74; 95% CI 1.72, 2.04) |
Black et al. [90] | 2019 | Opioids | Australia | 3225 | Determine factors associating with opioid use | • Population-averaged prevalence of opioid use 33%, and 62% reported ever-use over 5 years of follow-up • Opioid use higher in females and decreased with older baseline age |
Curtis et al. [21] | 2017 | Opioids | North America | 70,929 | Examine trends over time and variability in individual physician prescribing of opioids | • In average rheumatologist’s practice, 40% of RA patients used prescription opioids regularly • Factors associated with regular use of opioids included younger age, female sex, African American race, back pain, fibromyalgia, anxiety, and depression • Patients cared for by the same physician 25% more likely to be regular opioid users |
Huang et al. [81] | 2021 | Opioids | North America | 4.5 million outpatient visits | Examine outpatient opioid prescribing practices and factors associated with opioid prescriptions in patient visits | • 24.3% of visits led to opioid prescriptions, which increased over time • Several factors (patient and provider) associated with opioid prescribing including age, ethnicity, and other medicines |
Lee et al. [92] | 2019 | Opioids | North America | 26,288 | Examine trends in chronic opioid use in 2002 to 2015 and identify clinical predictors | • Chronic opioid use doubled from 2002 to 2015, from 7.4 to 16.9% • Pain and antidepressant use were strongest predictors of chronic opioid use |
Lee et al. [88] | 2020 | Opioids | North America | 9337 | Examine whether a physician’s past opioid prescribing practice associates with long-term opioid use by their patients | • Clinician’s baseline opioid prescribing practice significant predictor of whether a patient will become a long-term opioid user |
Machado-Duque et al. [86] | 2020 | Opioids | Columbia | 1329 | Determine trends in use of opioids | • 84.9% used opioids for at least 1 month • 46.7% used opioids for ≥ 12 months • Increasing age and other medicine use (e.g. antidepressants, biologics, glucocorticoids) associated with significantly increased risk of chronic opioid use |
Navarro-Millan et al. [87] | 2020 | Opioids | North America | 12,931 to 15,599 | Determine racial/ethnic differences in use of opioids in people no longer working due to disability | • 61.1 to 63.8% were chronic opioid users (depending on the year considered) • Higher chronic opioid use in people of white ethnicity compared to other ethnicities |
Park et al. [89] | 2019 | Opioids | North America | 2330 | Examine changes in opioid utilisation after initiation of anti-TNF | • Small decrease in overall opioid utilisation after anti-TNF initiation, falling from 54.0 to 51.0% |
Baser et al. [100] | 2013 | NSAIDs | Turkey | 2613 | Estimate and identify determinants of direct medical costs associated with RA in Turkey. Costs examined over 12-month period following index date | • Most patients were prescribed NSAIDs over 12-month follow-up period (90% with incident and 93% with prevalent RA) |
Crossfield et al. [83] | 2021 | NSAIDs | UK | 71,411 | Assess whether modern RA management has reduced long-term prescriptions of oral corticosteroids and NSAIDs | • Long-term NSAID prescribing declined from 45.9% of patients in 1998, to 25.1% in 2017 |
Hirata et al. [80] | 2021 | NSAIDs | Japan | 6407 | Investigate the prescribing trend patterns of biologic DMARDs | • 70.4% of patients receiving a biologic in 2012 were also prescribed an NSAID. This declined over time (last analysis year 2018) |
Palsson et al. [75] | 2024 | NSAIDs | Iceland | 359 | Study the impact of anti-TNF therapy on the use of NSAIDs in patients with RA | • Mean annual daily doses of NSAIDs fell from 148 to 86 in the 2 years pre- and post-starting anti-TNF (by 42%) |
Katada et al. [99] | 2015 | NSAIDs | Japan | 5126 | Investigate prescription patterns and trends for anti-rheumatic drug use | • In incident RA, more patients received first line treatment with NSAIDs than DMARDs |
Accortt et al. [95] | 2017 | Opioids and NSAIDs | North America | 6737 | Evaluate healthcare utilisation before and after initiation etanercept | • Significant reduction in opioid (54.8 to 52.2%) and oral NSAID (50.8 to 39.4%) use pre- and-post therapy |
Gadzhanova and Roughead [77] | 2024 | Opioids and NSAIDs | Australia | 18,360 | Examine analgesic use around the initiation of biologic DMARDs | • NSAID use was less in the 12 months before vs. 12 months after TNF-initiation (19 vs. 13%) although levels of use were declining significantly prior to anti-TNF initiation • Opioid use was similar (15 vs 17%) |
Hunter et al. [82] | 2021 | Opioids, NSAIDs, neuromodulators, topical pain treatments, non-narcotic analgesics | North America | 34,047 | Compare analgesic use in incident RA vs controls over 2 years and examine changes in pain medication use pre/post-biologics | • 83.0% used pain medication(s) at baseline • NSAID and opioid use fell pre- vs post-biologic initiation (NSAIDs 61.1 vs. 41.5% and opioids 52.0 vs. 40.4%) |
Jobski et al. [96] | 2017 | Opioids, NSAIDs, neuromodulators | Germany | 3140 | Assess pharmacological treatment with respect to pain and depression | • 65.5% received analgesics • Analgesic use increased with pain intensity levels • For all pain levels, analgesic use higher in those with moderate to severe vs. mild or no depressive symptoms |
Kawai et al. [101] | 2011 | Opioids and NSAIDs | North America | 32,476 | Study association between DMARD initiation and co-therapy use | • DMARD initiation associated with proportion of NSAID users declining by 13%; the proportion of narcotic users changed little by 2.5% |
Kern et al. [94] | 2018 | Opioids and “any pain medication” | North America | 63,101 | Examine treatment patterns in newly diagnosed patients | • 77.8% received any pain medication and 65.2% an opioid anytime post-index date |
Scott et al. [20] | 2024 | Basic analgesics, opioids, NSAIDs, gabapentinoids | England | 51,177 to 88,097 | Describe analgesic prescribing and its variation and determine prognostic factors for chronic analgesic prescriptions | • From 2004 to 2020, NSAID use declined substantially, opioid use fell slightly, and gabapentinoid use increased • Prescribing of non-NSAID analgesics greatest in people living in areas of deprivation, older people, and females |