All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors.
All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors.
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DOI：
10.1016/j.drugalcdep.2020.108291
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发表时间：
2020-11-01
影响因子：
4.2
通讯作者：
Becker WC
中科院分区：
文献类型：
--
作者：
Gordon KS;Manhapra A;Crystal S;Dziura J;Edelman EJ;Skanderson M;Kerns RD;Justice AC;Tate J;Becker WC
虽然长期阿片类药物治疗（LTOT）剂量和过量之间的关系已经得到了很好的证实，但LTOT与全因死亡率的关系却鲜为人知，特别是在艾滋病毒感染者（PLWH）中。关于LTOT停止或中断与死亡率相关性的信息也有限。在PLWH和匹配的未感染的男性退伍军人护理中，我们确定了那些启动LTOT的人。使用时间更新的考克斯回归，我们检查了全因死亡率，非自然死亡和过量与阿片类药物使用之间的关系，阿片类药物使用分为1-20（参考组），21-50，51-90和≥ 91 mg吗啡等效日剂量（MEDD）。有22，996名患者接受LTOT，6，578名（29%）PLWH和16，418名（71%）未感染。在5,222例（23%）死亡中，12%是非自然死亡，6%是过量死亡。MEDD与所有3种结局的风险相关;与接受1-20 mg MEDD的患者相比，全因死亡率的校正风险单调增加（21-50 mg MEDD的风险比（HR）[95%CI]= 1.36 [1.21，1.52]，51-90 mg MEDD = 2.06 [1.82，2.35]，≥ 91 mg MEDD = 3.03 [2.71，3.39]）。在按艾滋病毒分层的模型中也看到了类似的结果。LTOT中断也与全因、非自然和药物过量死亡相关（HR [95% CI]分别为2.30 [2.09，2.53]、1.47 [1.13，1.91]和1.52 [1.04，2.23]）。在PLWH和接受LTOT的未感染患者中，我们观察到所有3种死亡率结局均存在强烈的剂量-反应关系。应扩大阿片类风险缓解方法，以解决除非自然和过量死亡外，更高剂量对全因死亡的潜在影响。
While the relationship between long-term opioid therapy (LTOT) dose and overdose is well-established, LTOT’s association with all-cause mortality is less understood, especially among people living with HIV (PLWH). There is also limited information regarding the association of LTOT cessation or interruption with mortality. Among PLWH and matched uninfected male veterans in care, we identified those who initiated LTOT. Using time-updated cox regression, we examined the association between all-cause mortality, unnatural death, and overdose, and opioid use categorized as 1–20 (reference group), 21–50, 51–90, and ≥ 91 mg morphine equivalent daily dose (MEDD). There were 22,996 patients on LTOT, 6,578 (29%) PLWH and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. MEDD was associated with risk of all 3 outcomes; compared to patients on 1–20 mg MEDD, adjusted risk for all-cause mortality monotonically increased (Hazard Ratios (HR) [95% CI] for 21–50 mg MEDD = 1.36 [1.21, 1.52], 51–90 mg MEDD = 2.06 [1.82, 2.35], and ≥ 91 mg MEDD = 3.03 [2.71, 3.39]). Similar results were seen in models stratified by HIV. LTOT interruption was also associated with all-cause, unnatural, and overdose mortality (HR [95% CI] 2.30 [2.09, 2.53], 1.47 [1.13, 1.91] and 1.52 [1.04, 2.23], respectively). Among PLWH and uninfected patients on LTOT we observed a strong dose-response relationship with all 3 mortality outcomes. Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all-cause mortality in addition to unnatural and overdose fatalities.
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影响因子：
6.2
作者：
Roy, Sabita;Ninkovic, Jana;Banerjee, Santanu;Charboneau, Richard Gene;Das, Subhas;Dutta, Raini;Kirchner, Varvara A.;Koodie, Lisa;Ma, Jing;Meng, Jingjing;Barke, Roderick A.
通讯作者：
Barke, Roderick A.
影响因子：
7.4
作者：
Ekholm, Ola;Kurita, Geana Paula;Sjogren, Per
通讯作者：
Sjogren, Per
影响因子：
9.8
作者：
Oh, Tak Kyu;Jeon, Young-Tae;Choi, Jae Wook
通讯作者：
Choi, Jae Wook
DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
4
作者：
Chapman, C. Richard;Lipschitz, David L.;Weisner, Constance M.
通讯作者：
Weisner, Constance M.