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Opioids: no quality of life benefits for OA patients

Presented by
Dr Raveendhara Bannuru, Tufts Medical Center, USA
ACR 2019
A meta-analysis showed that particularly strong opioids should be avoided in osteoarthritis (OA) patients due to their unfavourable benefit-risk ratio [1].

The United States is in the throes of an opioid epidemic, a development that might spill over to Europe. However, opioids have major safety concerns. The lack of information about opioids’ efficacy for OA pain relief, and no clear delineation between overall efficacy and safety between strong and weak opioids, prompted the meta-analysis. “Given the current controversy regarding the use of opioids in chronic pain, we wanted to delve deeper into the efficacy and safety profiles of oral opioid drugs in OA patients. Temporal assessments can reveal peak periods of efficacy and can provide clinicians with a blueprint for optimal durations of treatment regimens,” said Dr Raveendhara Bannuru (Tufts Medical Center, Boston, USA), the study’s lead author.

The meta-analysis assessed the role of weak versus strong opioids for the management of pain and function in patients with knee and/or hip OA at 2, 4, 8, and 12 weeks. As much as 23 randomised controlled trials were included, there were 11,402 participants, 64% of them female. Overall, the results showed that opioids demonstrated small, but statistically significant benefits on pain at each time point. Similarly, the researchers observed small, statistically significant effects on function at 2, 4, 8, and 12 weeks. Interestingly, opioids had no impact on quality of life or depression.

Strong opioids should be avoided

Strong opioids consistently had smaller benefits on pain than weak opioids. In addition, they contributed no measurable benefit to quality of life or depression versus placebo. “Strong opioids’ underperformance was the study’s most interesting finding, and likely due to the relationship between pain relief and tolerability of opioids based on dose,” said Dr Bannuru. “We observed a relevant relationship between morphine dose equivalency and the magnitude of pain relief at the final follow-up. However, the relative risk of discontinuation due to adverse events among participants receiving strong opioids was nearly twice that of participants receiving weak opioids. These results suggest that many people who receive strong opioids may be unable to achieve the optimal therapeutic dose due to a lack of tolerability.” Strong opioids overall showed a consistently worse safety profile than weak opioids, particularly drug withdrawal symptoms.

    1.  Bannuru R, et al. Abstract 910. ACR 2019. November 8-13, Atlanta (GA/USA).

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