The comparative safety of analgesics in older adults with arthritis

January 01, 0001

The comparative safety of analgesics in older adults with arthritis

These US authors examined the comparative safety of nonselective NSAIDs (nsNSAIDs), selective cyclooxygenase 2 inhibitors (coxibs), and opioids for analgesia in older adults with arthritis. They identified 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. They studied the risk of adverse events related to analgesics using incidence rates and adjusted hazard ratios (HRs) from Cox proportional hazards regression.

They found: "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) and opioids (1.77) exhibited elevated relative risk for cardiovascular events. Gastrointestinal tract bleeding risk was reduced for coxib users (HR, 0.60) 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). Use of opioids (HR, 1.68) 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) but not coxibs raised the risk of all-cause mortality compared with use of nsNSAIDs."

The authors concluded: "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."

These are observational data that don’t demonstrate causality, but the differences in observed safety profile suggest more caution with opioids.

For the full abstract, click here.

Arch Intern Med 170(22):1968-1978, 13/27 December 2010
© 2010 to the American Medical Association
The Comparative Safety of Analgesics in Older Adults With Arthritis. Daniel H. Solomon, Jeremy A. Rassen, Robert J. Glynn, Joy Lee, Raisa Levin, Sebastian Schneeweiss. Correspondence to Dr. Solomon: [email protected]

Category: A. General/Unspecified, M. Musculoskeletal. Keywords: arthritis, pain, analgesia, older adults, opioids, nonselective nonsteroidal anti-inflammatory drugs, NSAIDs, cyclooxygenase 2 inihibitors, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 11 January 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.