SAFETY OFANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS

Fuggle, N.R.; Curtis, E.M.; Shaw, S.; Spooner, L.; Bruyère, O.; Ntanil, G.; Parsons, C.; Conaghan, P.G.; Corp, N.; Honvo, G.; Maggi, S.; Uebelhart, D.; Baird, J.; Dennison, E.M.; Reginster, J.-Y.; Cooper, C.

Abstract

Objectives: To assess the safety of opioids and COX-2 inhibitors in the management of osteoarthritis (OA) in a systematic review and meta-analysis of randomized, placebo-controlled trials.

Materials and methods: A comprehensive literature search was undertaken in the databases MEDLINE, Cochrane Central Register of Controlled Trials (Ovid CENTRAL), and Scopus. Randomized, double-blind, placebo-controlled, parallel-group trials that assessed adverse events (AEs) with opioids or COX-2 inhibitors in patients with OA were eligible for inclusion. The primary outcomes were severe and serious AEs, as well as MedDRA System Organ Class (SOC)-related Es:gastrointestinal (GI) disorders, cardiac disorders, vascular disorders, nervous system disorders, and dermatologic disorders. Results: For opioids, database searches identified 2189 records from which, after exclusions, 17 papers were included in the meta-analysis. More disorders of the lower gastrointestinal (GI) tract (constipation, fecaloma) were reported with both immediate-release (IR) and extended release (ER) formulations of opioids versus placebo: IR opioids (relative risk [RR] = 5.20, 95% confidence interval [CI] 3.42, 7.89); ER opioids (RR = 4.22, 95% CI 3.44, 5.17). The risk of risk of nausea, vomiting or loss of appetite increased 4 to 5-fold with both IR (RR = 3.39, 95% CI 2.22, 5.18) and ER opioids (RR = 4.03, 95% CI 3.37, 4.83). An increased risk of dermatologic AEs (rash and pruritis) (IR opioids: RR = 3.60, 95% CI 1.74, 7.43; ER opioids: RR = 7.87, 95% CI, 5.20, 11.89). For COX-2 inhibitors, database searches identified 2149 records from which, after exclusions, 40 trials were included in the meta-analysis. The use of COX-2 inhibitors in OA was associated with a significantly increased risk of drugrelated AEs compared with placebo (relative risk [RR] = 1.26, 95% CI 1.09, 1.46; I2 = 24%). The risk of upper gastrointestinal complications (including dyspepsia, gastritis, and heartburn) was significantly increased with COX-2 inhibitors versus placebo (RR = 1.19, 95% CI 1.03, 1.38; I2 = 0%). The risk of heart failure and edema was increased by nearly 70% with COX-2 inhibitors versus placebo (RR = 1.68, 95% CI 1.22, 2.31; 0%).

Conclusions: Our results confirm the concerns regarding safety and tolerability surrounding the use of opioids and COX-2 inhibitors in OA

Citation

Fuggle, N., Curtis, E., Shaw, S., Spooner, L., Bruyère, O., Ntanil, G., Parsons, C., Conaghan, P., Corp, N., Honvo, G., Maggi, S., Uebelhart, D., Baird, J., Dennison, E., Reginster, J.-Y., & Cooper, C. (2019, April). SAFETY OFANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS. Poster presented at World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2019), Paris, France

• Presentation Conference Type: Poster
• Conference Name: World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2019)
• Start Date: Apr 4, 2019
• End Date: Apr 7, 2019
• Deposit Date: Jun 27, 2023
• Public URL: https://keele-repository.worktribe.com/output/508697