Major adverse cardiovascular events and mortality with opioids versus non-steroidal anti-inflammatory drugs (NSAIDs) initiation in patients with rheumatoid arthritis
Main finding · MACEResult — go to the resultHazard ratio 1.02 95% CI 0.85–1.22Authors' conclusion
Opioids had similar MACE risk compared with NSAIDs in patients with RA with increased all-cause mortality and likely VTE, which suggests that opioids are not safer than NSAIDs, as clinicians have perceived.
Study context
- Population
- Patients with rheumatoid arthritis (RA) in FORWARD, The National Databank for Rheumatic Diseases, with ≥1 year participation, 1998–2021
- Participants
- 6,866 vs 13,689
- Exposure
- Opioid initiation vs NSAID initiation
- Opioidsn = 6,866
- NSAIDsn = 13,689reference
- Outcome
- Composite major adverse cardiovascular event (MACE):
- MI
- Stroke
- HF
- Cardiovascular disease (CVD) death
- VTE
Methodological detailsnew-user active comparator, propensity-score matched (1:2), Cox proportional hazards with PS weights
- New-user active comparator
- Propensity-score matched (1:2)
- Cox proportional hazards with PS weights
Main finding
MACE
Hazard ratio
1.02
95% CI 0.85–1.22
Events by group
Opioids
20.6/1000 PY
212 of 6866
NSAIDs
18.9/1000 PY
253 of 13 689
Opioidsvs NSAIDs
HR 1.02 (95% CI 0.85–1.22)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Opioids | NSAIDs | HR (95% CI) | |
|---|---|---|---|---|
| All-cause mortalityPS-weighted model; 33% higher | 13.5/1000 PY | 10.8/1000 PY | 1.33 (1.06–1.67) | |
| VTE (individual MACE component)Tended to be higher | 1.41 (0.84–2.35) | |||
| 0.512Hazard ratio (log scale) |
All-cause mortality and venous thromboembolism (VTE) by opioid strength
- Strong opioids had a higher risk for all-cause mortality and VTE than weak opioids compared with NSAIDs, suggesting a dose-dependent association
Original publication
Major adverse cardiovascular events and mortality with opioids versus NSAIDs initiation in patients with rheumatoid arthritis. Ann Rheum Dis. Published 17 July 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →