Opioid Analgesics and the Risk of Serious Infections Among Patients With Rheumatoid Arthritis: A Self-Controlled Case Series Study.
Opioid Analgesics and the Risk of Serious Infections Among Patients With Rheumatoid Arthritis: A Self-Controlled Case Series Study.
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DOI：
10.1002/art.39462
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Grijalva CG
中科院分区：
文献类型：
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作者：
Wiese AD;Griffin MR;Stein CM;Mitchel EF Jr;Grijalva CG
动物和体外研究表明，某些阿片类镇痛剂损害关键的免疫功能。我们试图确定阿片类药物的使用是否与类风湿关节炎（RA）患者严重感染的风险增加有关。我们对田纳西州医疗补助计划（1995-2009年）招募的13，796例RA患者进行了回顾性队列的自我对照病例系列分析。我们使用条件泊松回归对阿片类药物使用期间与不使用期间因严重感染住院的风险进行了人内比较。固定混杂因素按设计进行解释，随时间变化的混杂因素包括年龄、缓解疾病的抗风湿药物、糖皮质激素和质子泵抑制剂的使用。其他分析检查了新阿片类药物的使用，已知具有免疫抑制特性的阿片类药物的使用，长效阿片类药物的使用和不同的阿片类药物剂量。敏感性分析解释了潜在的原发性偏倚和适应症混杂。在至少有一次因严重感染住院治疗的1，790例RA患者中，当前使用阿片类药物期间严重感染的校正发生率高于未使用期间[发生率比（IRR）：1.39（95%置信区间（CI）：1.19-1.62）]。长效阿片类药物使用、免疫抑制阿片类药物使用和新阿片类药物使用期间的发生率也高于未使用期间[IRR：2.01（95% CI：1.52-2.66）; IRR：1.72（95% CI：1.33-2.23）; IRR：2.38（95% CI：1.65-3.42）]。敏感性分析的结果与主要结果一致。在RA患者的人内比较中，阿片类药物的使用与因严重感染住院的风险增加相关。
Animal and in vitro studies suggest that certain opioid analgesics impair crucial immune functions. We sought to determine if opioid use is associated with an increased risk of serious infections in patients with rheumatoid arthritis (RA). We conducted a self-controlled case series analysis on a retrospective cohort of 13,796 patients with RA enrolled in Tennessee Medicaid (1995–2009). We performed within-person comparisons of the risk of hospitalizations for serious infections during periods of opioid use compared with non-use using conditional Poisson regression. Fixed confounders were accounted for by design, and time-varying confounders included age, the use of disease-modifying anti-rheumatic drugs, glucocorticoids and proton-pump inhibitors. Additional analyses examined new opioid use, use of opioids known to have immunosuppressive properties, long acting opioid use, and different opioid dosages. Sensitivity analyses accounted for potential protopathic bias and confounding by indication. Among 1,790 patients with RA who had at least one hospitalization for serious infection, the adjusted incidence rate of serious infection was higher during periods of current opioid use compared with non-use [incidence rate ratio (IRR): 1.39 (95% confidence interval (CI): 1.19–1.62)]. The incidence rate was also higher during periods of long-acting opioid use, immunosuppressive opioid use and new opioid use compared with non-use [IRR: 2.01 (95% CI: 1.52–2.66); IRR: 1.72 (95% CI: 1.33–2.23); IRR: 2.38 (95% CI: 1.65–3.42), respectively]. Results of sensitivity analyses were consistent with the main findings. In within-person comparisons of patients with RA, opioid use was associated with an increased risk of hospitalizations for serious infection.