DENVER (FRONTLINE MEDICAL NEWS) – Even as prescribing of tumor necrosis factor inhibitors for patients with ankylosing spondylitis climbed in the last half-dozen years, patients’ use of prescription narcotics increased as well.

This was the unexpected finding of a comprehensive analysis of trends in medication use over a 12-year period among 1,018 ankylosing spondylitis patients participating in the ongoing multicenter Prospective Study of Outcomes in Ankylosing Spondylitis ( PSOAS ), Dr. Mary C. Gibson reported at the annual meeting of the Spondyloarthritis Research and Treatment Network.

“Even with treatment with TNF inhibitors, patients are often requiring additional pain control with narcotic medications. This could reflect inadequate pain control from directed therapy or a trend toward change in pain control use in general practice,” observed Dr. Gibson of the University of Texas, Houston.

The patients enrolled in PSOAS during 2003-2014 are being followed longitudinally. They were recruited from community practice settings as well as academic centers. Dr. Gibson analyzed their medication use at the time of their baseline enrollment visit on a year-by-year basis, then stepped back to look at broader trends, comparing baseline medication use for patients enrolled in 2003-2008 to those enrolled during 2009-2014.

Not surprisingly, significantly more patients entered the study on a TNF inhibitor during the enrollment years 2009-2014 than during the first half of the study period: 49% compared with 37% during 2003-2008. What came as a surprise, however, was the time trend in narcotic use: 14.6% of ankylosing spondylitis patients in the 2003-2008 cohort were on narcotics, compared with 19.3% who enrolled since then.

“That’s a little bit troubling,” said Dr. John D. Reveille, professor and vice chair of rheumatology at the University of Texas, Houston, and head of PSOAS.

Oxycodone use nearly tripled between the first and second half of the study period: 1.1% were on the drug at enrollment in 2003-2008 compared with 3.1% in 2009-2014.

Of note, baseline use of oxycodone peaked in the enrollment class of 2012, 5.6% of whom were on the medication when they joined PSOAS. For narcotics overall, the peak year was 2008: over 27% of patients who enrolled in the study that year were on narcotic therapy at the time.

The use of NSAIDs – a guideline-recommended first-line therapy in ankylosing spondylitis – trended lower over time, albeit not significantly so. Among patients who enrolled in PSOAS during 2003-2008, over 70% were on NSAID therapy, compared with 66% of those who enrolled later.

There was no significant change over time in the use of DMARDs, psychoactive medications, muscle relaxants, or corticosteroids.

PSOAS is sponsored by the National Institutes of Health. Dr. Gibson reported having no financial conflicts.


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