Opioid use associated with an increased risk of adverse effects in the elderly (science daily)

PharmaLive.com (16 December 2010) - opioids appear to be associated with more adverse seniors suffering from arthritis that another commonly used analgesics, including coxibs and anti-inflammatory nonsteroidal, according to a report by December 13 27 issue of the archives of Internal Medicine, one of the JAMA/Archives Journals. In a second report assessing use only to opiates, different types of drugs in the class were associated with different security events in older patients with non-malignant pain.

"At United States, one in five adults received an order for analgesic in 2006, cash for purchases of 230 million; prescription" However, the comparative safety of these drugs is not clear "the authors write as background information in one of the articles." ' While heart safety of non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) and selective inhibitors of cyclooxygenase-2 (coxibs) has been challenged, it is little comparable information on the third major analgesic group opioid. ".

In the first report, Daniel Solomon, M.D., M.P.H. Brigham colleagues and hospital for women, Boston, examined the comparative safety of nsNSAIDs coxibs and opioid 12,840 Medicare beneficiaries who received at least one of these pain relievers between 1999 and 2005. Using data from a database using significant health care (applications), the authors evaluated the occurrence of cardiovascular events, heart attack, stroke stroke and cardiac insufficiency among others), gastrointestinal events (GI tract bleeding and intestinal obstruction), renal acute injuries, toxic effects on the liver, as well as the falls and fractures.

Opioid users have experienced higher rates for most types of serious adverse events than patients taking nsNSAIDs and coxibs / nsNSAID known users lower risk. For example, fractures occurred between 101 by 1,000 users per year, compared to 19 per 1,000 per year among users of coxib opioids.

Coxibs and opioids appear to be associated with the heart risks than nsNSAIDs, but the use of opioids and coxibs has been associated with a higher risk of hospitalization or death than using nsNSAIDs. Conversely, the risk of bleeding from the gastrointestinal tract was reduced in those taking of coxibs (12 per 1,000 per year, compared with 21 per 1,000 per year between those taking a nsNSAIDs).

"Painkillers are used daily by millions of people." However, the current data do not patients or doctors to determine what type of agent is more secure. We compared nsNSAIDs, coxibs and opioids in a wide range of specific security and several events of composite security events "write the authors." "Although the nsNSAIDs pose some risks, these analyses support the safety of these agents compared with other analgesics." Recent concerns about using opioids in pain syndromes non-malignant appear to be justified on the basis of these data. »

In a second article, Dr. Solomon and his colleagues Brigham and women's Hospital not only studied Medicare beneficiaries receiving opioids non-malignant pain between 1996 and 2005. They compared the rates of adverse events after 30-180 days 6,275 patients each take one of the five types of opiates: codeine, hydrocodone, oxycodone, propoxyphene and tramadol.

The risk of GI adverse effects remained similar for all studied drugs and thirty days after the beginning of the opioid therapy the risk of cardiovascular events was also similar among all the types. However, after 180 days, the risk of cardiovascular events increased between those taking codeine. Hydrocodone as point of reference, fracture risk a 79 per cent lower among those taking tramadol and 46 percent lower among those taking propoxyphene. Compared to those taking hydrocodone, death from any cause was 2.4 times as likely among those taking of oxycodone and twice as likely among those taking codeine.

"The findings of this study do not accept with a commonly held belief that all opioids are associated with similar risks," write the authors. "The risks explained not by the prescribed dose and vary across a range of sensitivity analyses. Risks are significant and translated number needed to treat that would be considered clinically significant. Our conclusions regarding cardiovascular risk are surprising and require validation in other data sets. »

Proving that a relationship of cause and effect between the types of opioid and unwanted requires an experimental rather than the design of the observational study, they note, but these results should encourage careful and thorough. »

In addition, research letter published in the same issue, found double the risk of cardiovascular events in patients followed for a median (middle) 189 days after taking rofecoxib analgesic drug during offshore drug followed by a clinical trial. Joseph s. Ross, M.D., M.H.S., school of medicine, Yale University, and colleagues analyzed data from clinical trial which become available through litigation. Twenty - two cardiovascular events and 23 deaths occurred in patients taking rofecoxib in trial, compared to six cardiovascular events and nine deaths among the participants who took a placebo.

Studies were funded by grants and contracts from the Agency for healthcare quality and research, U.S. Department of Health and Human Services, the evidence to inform decisions regarding effectiveness (decision) development program.

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Source of the story:

The story above is reproduced (with drafting adaptations by staff at PharmaLive.com) materials provided by JAMA and archives of newspapers.

Reference of the review:

Continuing after the abandonment of rofecoxib cardiovascular risk by Joseph s. Ross et al. Arch Intern Med., 2010; 170 (22): 2035-2036 DOI: 10.1001/archinternmed.2010.461

Note: If no author is given, the source is cited for this.