ABSTRACT
Background: Non-opioid analgesics are prescribed in combination with opioids among patients with long bone fracture to reduce opioid prescribing needs, yet evidence is limited on whether they reduce the risk of serious opioid-related events (SOREs). We compared the risk of SOREs among hospitalized patients with long bone fracture discharged with filled opioid prescriptions, with and without non-opioid analgesics. Design: We identified a retrospective cohort of analgesic-naïve adult patients with a long bone fracture hospitalization using the Merative MarketScan Commercial Database (2013-2020). The exposure was opioid and non-opioid analgesic (gabapentinoids, muscle relaxants, non-steroidal anti-inflammatory drugs, acetaminophen) prescriptions filled in the 3 days before through 42 days after discharge. The outcome was the development of new persistent opioid use or opioid use disorder during follow-up (day 43 through day 408 after discharge). We used Cox proportional hazards regression with inverse probability of treatment weighting with overlap trimming to compare outcomes among those that filled an opioid and a non-opioid analgesic to those that filled only an opioid analgesic. In secondary analyses, we used separate models to compare those that filled a prescription for each specific non-opioid analgesic type with opioids to those that filled only opioids. Results: Of 29 489 patients, most filled an opioid prescription alone (58.4%) or an opioid and non-opioid (22.0%). In the weighted proportional hazards regression model accounting for relevant covariates and total MME, filling both a non-opioid analgesic and an opioid analgesic was associated with 1.63 times increased risk of SOREs compared with filling an opioid analgesic only (95% CI 1.41 to 1.89). Filling a gabapentin prescription in combination with an opioid was associated with an increased risk of SOREs compared with those that filled an opioid only (adjusted HR: 1.84 (95% CI1.48 to 2.27)). Conclusions: Filling a non-opioid analgesic in combination with an opioid was associated with an increased risk of SOREs after long bone fracture. Level of evidence: Level III, prognostic/epidemiological. Study type: Retrospective cohort study.
ABSTRACT
This cross-sectional study examines spending by health care plans and enrollees on products with accelerated approval.
Subject(s)
Health Benefit Plans, Employee , Health Expenditures , Humans , Cost Sharing , Pharmaceutical PreparationsABSTRACT
This cross-sectional study examines and compares the time taken from the accelerated approval of cancer and noncancer drugs to the initiation of confirmatory studies in the US.
Subject(s)
Antineoplastic Agents , Neoplasms , Humans , United States , Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Drug Approval , United States Food and Drug AdministrationABSTRACT
The dataset summarized in this article includes a nationwide prevalence sample of U.S. military Veterans who were aged 65 years or older, dually enrolled in the Veterans Health Administration and traditional Medicare and had a previous diagnosis of diabetes (diabetes mellitus) as of December 2005 (N = 275,190) [1]. Our data were originally used to develop and validate prognostic indices of 5- and 10-year mortality among older Veterans with diabetes. We include various potential predictors including demographics (e.g., sex, age, marital status, and VA priority group), healthcare utilization (e.g., # of outpatient visits, # days of inpatient stays), medication history, and major comorbidities. This novel dataset provides researchers with an opportunity to study the associations between a large variety of individual-level risk factors and longevity for patients living with diabetes.