TY - JOUR
T1 - Associations of opioid prescriptions with death and hospitalization across the spectrum of estimated gfr
AU - Novick, Tessa K.
AU - Surapaneni, Aditya
AU - Shin, Jung Im
AU - Alexander, G. Caleb
AU - Inker, Lesley A.
AU - Wright, Eric A.
AU - Chang, Alex R.
AU - Grams, Morgan E.
N1 - Funding Information:
This study was reviewed and approved by the Johns Hopkins University Bloomberg School of Public Health and Geisinger Medical Center Institutional Review Board.
Funding Information:
Dr. Alexander reports that he was past chair of the Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee; has served as a paid advisor to IQVIA; is a cofounding principal and equity holder in Monument Analytics, a healthcare consultancy whose clients include the life sciences industry, as well as plaintiffs in opioid litigation; and is a member of OptumRx’s National Pharmacy & Therapeutics Committee. These associations have been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Dr. Grams reports travel expenses paid by Dialysis Clinic Inc. and Kidney Disease Improving Global Outcomes. Dr. Inker reports receiving grants from the National Institutes of Health (NIH), the National Kidney Foundation, Omeros, and Reata Pharmaceuticals for research and contracts with the Paul Teschan Research Fund and Tufts Medical Center, outside of the submitted work. Dr. Inker also reports participation in consulting agreements with Omeros and Tri-cida and a position on the medical advisory board for Alport Syndrome Foundation. Dr. Inker further reports a patent issued for precise estimation of GFR from multiple biomarkers (PCT/US2015/044567). Dr. Chang, Dr. Novick, Dr. Shin, Dr. Surapaneni, and Dr. Wright have nothing to disclose.
Funding Information:
Research reported in this publication was supported by grants from NIH/National Institute of Diabetes and Digestive and
Funding Information:
KidneyDiseases(NIDDK)toDr.CoreshandDr.Inker(R01DK100446) and Dr. Grams and Dr. Inker (R01 DK115534). Dr. Novick was supported by NIH/NIDDK under award number T32DK7732-24.
PY - 2019/11/7
Y1 - 2019/11/7
N2 - Background and objectives Most opioids undergo kidney excretion. The goal of this study was to evaluate opioid-associated risks of death and hospitalization across the range of eGFR. Design, setting, participants, & measurements The study population included adult primary care patients in Geisinger Health (Danville, PA) between 2008 and 2017. People receiving their first opioid prescription were propensity matched to people receiving NSAIDS (and, in sensitivity analysis, gabapentinoids) and the risk of death and hospitalization were compared, classifying opioid medication exposure as time-varying daily oral morphine milligram equivalents (MMEs) across time-varying eGFR. Results The propensity-matched cohort included 46,246 patients prescribed either opioids or NSAIDs between 2008 and 2017 (mean [SD] age, 54 [16] years; 56% female; 3% of black race). Prescriptions for 1–59 and $60 MMEs were associated with higher risk of death (HR, 1.70; 95% CI, 1.41 to 2.05 for 1–59 MMEs; HR, 2.25; 95% CI, 1.82 to 2.79 for $60 MMEs) and hospitalization (HR, 1.38; 95% CI, 1.30 to 1.46 for 1–59 MMEs; HR, 1.68; 95% CI, 1.56 to 1.81 for $60 MMEs) compared with NSAID prescriptions, when evaluated at eGFR 80 ml/min per 1.73 m2. The relative risk of death associated with $60 MMEs was higher at lower GFR (e.g., eGFR, 40 ml/min per 1.73 m2; HR, 3.94; 95% CI, 2.70 to 5.75; P for interaction, 0.01). When gabapentinoids were used as the comparison medication, only $60 MMEs were significantly associated with higher risk of death (HR, 2.72; 95% CI, 1.71 to 4.34), although both 1–59 and $60 MMEs were associated with risk of hospitalization (HR, 1.22; 95% CI, 1.04 to 1.43 for 1–59 MMEs; HR, 1.54; 95% CI, 1.28 to 1.86 for $60 MMEs). Conclusions The receipt of prescription opioids was associated with a higher risk of death and hospitalization compared with other pain medications, particularly with higher doses and at lower eGFR.
AB - Background and objectives Most opioids undergo kidney excretion. The goal of this study was to evaluate opioid-associated risks of death and hospitalization across the range of eGFR. Design, setting, participants, & measurements The study population included adult primary care patients in Geisinger Health (Danville, PA) between 2008 and 2017. People receiving their first opioid prescription were propensity matched to people receiving NSAIDS (and, in sensitivity analysis, gabapentinoids) and the risk of death and hospitalization were compared, classifying opioid medication exposure as time-varying daily oral morphine milligram equivalents (MMEs) across time-varying eGFR. Results The propensity-matched cohort included 46,246 patients prescribed either opioids or NSAIDs between 2008 and 2017 (mean [SD] age, 54 [16] years; 56% female; 3% of black race). Prescriptions for 1–59 and $60 MMEs were associated with higher risk of death (HR, 1.70; 95% CI, 1.41 to 2.05 for 1–59 MMEs; HR, 2.25; 95% CI, 1.82 to 2.79 for $60 MMEs) and hospitalization (HR, 1.38; 95% CI, 1.30 to 1.46 for 1–59 MMEs; HR, 1.68; 95% CI, 1.56 to 1.81 for $60 MMEs) compared with NSAID prescriptions, when evaluated at eGFR 80 ml/min per 1.73 m2. The relative risk of death associated with $60 MMEs was higher at lower GFR (e.g., eGFR, 40 ml/min per 1.73 m2; HR, 3.94; 95% CI, 2.70 to 5.75; P for interaction, 0.01). When gabapentinoids were used as the comparison medication, only $60 MMEs were significantly associated with higher risk of death (HR, 2.72; 95% CI, 1.71 to 4.34), although both 1–59 and $60 MMEs were associated with risk of hospitalization (HR, 1.22; 95% CI, 1.04 to 1.43 for 1–59 MMEs; HR, 1.54; 95% CI, 1.28 to 1.86 for $60 MMEs). Conclusions The receipt of prescription opioids was associated with a higher risk of death and hospitalization compared with other pain medications, particularly with higher doses and at lower eGFR.
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U2 - 10.2215/CJN.00440119
DO - 10.2215/CJN.00440119
M3 - Article
C2 - 31582462
AN - SCOPUS:85074676145
VL - 14
SP - 1581
EP - 1589
JO - Clinical journal of the American Society of Nephrology : CJASN
JF - Clinical journal of the American Society of Nephrology : CJASN
SN - 1555-9041
IS - 11
ER -