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

Research output: Contribution to journalArticle

238 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1968-1978
Number of pages11
JournalArchives of Internal Medicine
Volume170
Issue number22
DOIs
StatePublished - Dec 13 2010
Externally publishedYes

Fingerprint

Opioid Analgesics
Arthritis
Analgesics
Non-Steroidal Anti-Inflammatory Agents
Cyclooxygenase 2 Inhibitors
Safety
Confidence Intervals
Propensity Score
Medicare
Gastrointestinal Tract
Hospitalization
Hemorrhage
Mortality
Incidence

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Solomon, D. H., Rassen, J. A., Glynn, R. J., Lee, J., Levin, R., & Schneeweiss, S. (2010). The comparative safety of analgesics in older adults with arthritis. Archives of Internal Medicine, 170(22), 1968-1978. https://doi.org/10.1001/archinternmed.2010.391

The comparative safety of analgesics in older adults with arthritis. / Solomon, Daniel H.; Rassen, Jeremy A.; Glynn, Robert J.; Lee, Joy; Levin, Raisa; Schneeweiss, Sebastian.

In: Archives of Internal Medicine, Vol. 170, No. 22, 13.12.2010, p. 1968-1978.

Research output: Contribution to journalArticle

Solomon, DH, Rassen, JA, Glynn, RJ, Lee, J, Levin, R & Schneeweiss, S 2010, 'The comparative safety of analgesics in older adults with arthritis', Archives of Internal Medicine, vol. 170, no. 22, pp. 1968-1978. https://doi.org/10.1001/archinternmed.2010.391
Solomon, Daniel H. ; Rassen, Jeremy A. ; Glynn, Robert J. ; Lee, Joy ; Levin, Raisa ; Schneeweiss, Sebastian. / The comparative safety of analgesics in older adults with arthritis. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 22. pp. 1968-1978.
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