DMARD Use in RA May Lead to Decreased Risk of Long-Term Opioid Use

Treatment with disease-modifying antirheumatic drugs (DMARDs) may lower the risk of long-term opioid use in patients with rheumatoid arthritis (RA), according to a recent study presented during ACR Convergence 2021, the annual meeting of the American College of Rheumatology.¹

Investigators used the national Medicare database to perform a cross-sectional study between 2017 and 2018 that analyzed long-term opioid use in patients with RA who received at least 1 30-day opioid prescription. The risk of long-term opioid use was compared between DMARD- and non-DMARD users. The cohort was further divided based on DMARD regimen, set forth by the ACR, for treatment of RA.

Investigators identified 27,028 patients with RA who received at least a 30-day opioid prescription. The mean age of the cohort was 69.7 years; participants were 80% women, and 76.8% White; 11.7% were Black and 7.8% were Hispanic. Approximately 70% of patients were currently using DMARD therapy.

Long-term opioid use was lower among DMARD users compared to non-DMARD users: 37% and 43%, respectively. While risk factors for long-term opioid use—including depression, anxiety, bipolar disorder, drug use, and opioid use disorder—were prevalent in both DMARD and non-DMARD users, these factors occurred more often in non-DMARD users.

The following depicts the findings for risk factors rates for long-term opioid use in non-DMARD and DMARD users, respectively:

• Anxiety – 42.8% vs 31.9%
• Depression – 43.6% vs 36.6%
• Previous drug abuse – 18.6% vs 12.2%
• Previous opioid use disorder – 17% vs 11%

“DMARD use in [patients with RA] was associated with decreased risk of long-term opioid use,” the researchers concluded. “These agents represent a possible opportunity to lower the risk of long-term opioid use in an especially vulnerable population. Appropriate use of DMARDs in [patients with RA] may result in decreased dependence on opioids for chronic pain.”

Reference

1. Sood A, Kuo Y, Westra J, et al. DMARD use in Medicare patients with rheumatoid arthritis and risk of long-term opioid use. Presented at: ACR Convergence 2021; November 3-9, 2021. Abstract 0587.