The Comparative Safety of Analgesics in Older Adults With Arthritis
The Comparative Safety of Analgesics in Older Adults With Arthritis
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DOI：
10.1001/archinternmed.2010.391
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发表时间：
2010-12-13
影响因子：
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通讯作者：
Schneeweiss, Sebastian
中科院分区：
文献类型：
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作者：
Solomon, Daniel H.;Rassen, Jeremy A.;Schneeweiss, Sebastian
背景：替代镇痛药的安全性尚不清楚。我们检查了非选择性非甾体抗炎药（nsNSAIDs）、选择性环氧化酶2抑制剂（coxib）和阿片类药物的相对安全性。方法：1999年1月1日至2005年12月31日期间，宾夕法尼亚州和新泽西州开始接受非甾体抗炎药、coxib或阿片类药物治疗的医疗保险受益人在倾向评分上进行匹配。我们使用Cox比例风险回归的发生率和校正风险比（hr）研究了与镇痛药相关的不良事件的风险。结果：参与者的平均年龄为80.0岁，女性占85%。倾向评分匹配后，3个镇痛药队列在基线协变量上得到了很好的平衡。与nsnaids相比，coxibs （HR, 1.28； 95%可信区间[CI]， 1.01-1.62）和阿片类药物（1.77;1.39-2.24）心血管事件的相对风险升高。coxib服用者胃肠道出血风险降低（HR, 0.60; 95% CI, 0.35-1.00），但阿片类药物服用者相似。使用coxib和nsnaids导致类似的骨折风险；然而，使用阿片类药物会增加骨折风险（HR, 4.47; 95% CI, 3.12-6.41）。使用阿片类药物（HR, 1.68; 95% CI, 1.37-2.07）但不使用coxibs与使用nsNSAIDs相比，需要住院治疗的安全事件风险增加相关。此外，使用阿片类药物（HR, 1.87; 95 CI, 1.39-2.53）而不使用coxibs与使用nsNSAIDs相比，增加了全因死亡率的风险。结论：镇痛药的相对安全性取决于所研究的安全事件。阿片类药物的使用与非非甾体类抗炎药相比，显示出许多安全事件的相对风险增加。
Background: The safety of alternative analgesics is unclear. We examined the comparative safety of nonselective NSAIDs (nsNSAIDs), selective cyclooxygenase 2 inhibitors (coxibs), and opioids.Methods: Medicare beneficiaries from Pennsylvania and New Jersey who initiated therapy with an nsNSAID, a coxib, or an opioid from January 1, 1999, through December 31, 2005, were matched on propensity scores. We studied the risk of adverse events related to analgesics using incidence rates and adjusted hazard ratios (HRs) from Cox proportional hazards regression.Results: The mean age of participants was 80.0 years, and almost 85% were female. After propensity score matching, the 3 analgesic cohorts were well balanced on baseline covariates. Compared with nsNSAIDs, coxibs (HR, 1.28; 95% confidence interval [CI], 1.01-1.62) and opioids (1.77; 1.39-2.24) exhibited elevated relative risk for cardiovascular events. Gastrointestinal tract bleeding risk was reduced for coxib users (HR, 0.60; 95% CI, 0.35-1.00) but was similar for opioid users. Use of coxibs and nsNSAIDs resulted in a similar risk for fracture; however, fracture risk was elevated with opioid use (HR, 4.47; 95% CI, 3.12-6.41). Use of opioids (HR, 1.68; 95% CI, 1.37-2.07) but not coxibs was associated with an increased risk for safety events requiring hospitalization compared with use of nsNSAIDs. In addition, use of opioids (HR, 1.87; 95 CI, 1.39-2.53) but not coxibs raised the risk of all- cause mortality compared with use of nsNSAIDs.Conclusions: The comparative safety of analgesics varies depending on the safety event studied. Opioid use exhibits an increased relative risk of many safety events compared with nsNSAIDs.