Prescription Opioid Analgesic Use and Mortality in Systemic Lupus Erythematosus

Cabacungan, R. J.; Qualls, C. R.; Sibbitt, W. L.; Hayward, W. A.; Gibb, J. I.; Kettwich, S. D.; Fields, R. A.; Emil, N. S.; Fangtham, M.; Bankhurst, A. D.

doi:10.1101/395343

bioRxiv · 10.1101/395343

Prescription Opioid Analgesic Use and Mortality in Systemic Lupus Erythematosus

Cabacungan, R. J.·Qualls, C. R.·Sibbitt, W. L.·Hayward, W. A.·Gibb, J. I.·Kettwich, S. D.·Fields, R. A.·Emil, N. S.·Fangtham, M.·Bankhurst, A. D.

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Abstract

ObjectivesThis research investigated the prevalence of opioid analgesic use in patients with systemic lupus erythematosus (SLE).\n\nMethodsThis 5-year prospective cohort study of 275 SLE patients focused on prescription opioid use and 5-year outcome. Associations were determined with univariable regression analysis and then multivariable models were created to determine independent effects on dependent variables\n\nResultsPrescription opioid use was common in SLE with 24% using opioid analgesics chronically and 76% not using opioids. Opioid users had a higher rate of tobacco use (p<0.01), cocaine use (p<0.002), mean pain scores (p<0.001), disease activity (SLEDAI-2K) (p<0.001), disease damage (SLICC/ACRDI) (p<0.001), non-adherence to medical therapy (p<0.01), and total deaths at 5 years (opioids: 48.0%, no opioids 19.0%, p<0.001). Logistic regression analysis predicting death revealed opioid use (hazard ratio 2.6, p<0.001) and SLEDAI-2K (1.1, p<0.001) respectively; and opioid use (hazard ratio 2.5, p<0.002), SLEDAI-2K (hazard ratio 1.1, p<0.001), and non-adherence (hazard ratio 1.6, p=0.11), respectively. Multivariable Cox Model analysis estimating probability of death with covariates: opioid use (hazard ratio 2.6, p<0.001) and SLEDAI-2K (hazard ratio 1.1, p<0.001); opioid use (hazard ratios 3.0, p<0.001), and cocaine use (hazard ratio 3.2, p<0.001). The Kaplan-Meir survival analysis revealed a significantly higher probability of death for SLE patients using opioid analgesics.\n\nConclusionsPrescription opioid analgesic use is common in SLE and is associated with markedly increased mortality. Preferably, non-opioid approaches to treat chronic pain should be used in SLE patients.\n\nClinical trial registration numberThis was not a clinical trial.\n\nKEY MESSAGES1. Chronic opioid analgesic use is common in SLE (24%).\n\n2. Opioid use is associated with greater disease severity, tobacco use, non-adherence, and increased mortality.\n\n3. Opioids should be used cautiously in SLE; alternative non-opioid management of pain is recommended.\n\nACKNOWLEDGMENTS AND FUNDING INFORMATIONThis work was supported by US National Institutes of Health research grants to Dr. Sibbitt (R01 NS035708) and to the Clinical and Translational Research Center (UL1TR001449).

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Cabacungan, R. J., Qualls, C. R., Sibbitt, W. L., Hayward, W. A., Gibb, J. I., Kettwich, S. D., Fields, R. A., Emil, N. S., Fangtham, M., Bankhurst, A. D.. 2018-08-21. Prescription Opioid Analgesic Use and Mortality in Systemic Lupus Erythematosus. https://doi.org/10.1101/395343

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