Trends in Opioid Prescriptions in Individuals With Axial Spondyloarthritis in the United States and United Kingdom in the Last Two Decades: Analysis of Electronic Health Records and Insurance Claims Data.

OBJECTIVE

Prolonged opioid use occurs in 25% of individuals with axial spondyloarthritis (axSpA). Whether introduction of tumor necrosis factor inhibitors (TNFi) influenced secular trends in opioid prescription in axSpA is unknown. We examined opioid prescription trends in axSpA, relative to nonsteroidal anti-inflammatory drugs (NSAIDs) and TNFi, using two observational databases.

METHODS

We used data from IQVIA Medical Research Database (IMRD), a UK electronic health records-based database from 2000 to 2020, and Merative MarketScan (MarketScan), a US administrative claims-based database from 2006 to 2021. We included adults (18-89 years, IMRD; 18-65 years, MarketScan) with axSpA. We calculated annual prescription rates for opioids, NSAIDs, and TNFi (only in MarketScan) and estimated percentage changes in annual prescription rates by medication class using joinpoint regression.

RESULTS

We included 1,689 individuals from IMRD (mean age 47 years; 74% male) and 18,858 individuals from MarketScan (mean age 45 years; 51% male). In IMRD, annual opioid prescription rates decreased by 2.5% (95% confidence interval [CI] -9.1 to 1.9) between 2001 and 2007, increased by 3.9% (95% CI -3.0 to 14.2) between 2007 and 2016, and decreased by 0.4% (95% CI -11.2 to 2.9) between 2016 and 2020. In MarketScan, annual opioid prescription rates decreased by 1.5% (95% CI -3.0 to 2.0) in 2008 to 2016 and decreased by 8.6% (95% CI -15.2 to -5.7) in 2016 to 2021. TNFi prescriptions increased by 1.8% (95% CI 1.1 to 2.5) in 2008 to 2021.

CONCLUSION

Opioid prescription rates remained stable over time in the United Kingdom, whereas they slightly decreased in the United States as TNFi uptake increased. These trends may reflect a US nationwide change in guidance for opioid prescriptions issued in 2016.