| アブストラクト | Importance: An American Academy of Orthopaedic Surgeons guideline recommends tramadol for patients with knee osteoarthritis, and an American College of Rheumatology guideline conditionally recommends tramadol as first-line therapy for patients with knee osteoarthritis, along with nonsteroidal anti-inflammatory drugs. Objective: To examine the association of tramadol prescription with all-cause mortality among patients with osteoarthritis. Design, Setting, and Participants: Sequential, propensity score-matched cohort study at a general practice in the United Kingdom. Individuals aged at least 50 years with a diagnosis of osteoarthritis in the Health Improvement Network database from January 2000 to December 2015, with follow-up to December 2016. Exposures: Initial prescription of tramadol (n = 44451), naproxen (n = 12397), diclofenac (n = 6512), celecoxib (n = 5674), etoricoxib (n = 2946), or codeine (n = 16922). Main Outcomes and Measures: All-cause mortality within 1 year after initial tramadol prescription, compared with 5 other pain relief medications. Results: After propensity score matching, 88902 patients were included (mean [SD] age, 70.1 [9.5] years; 61.2% were women). During the 1-year follow-up, 278 deaths (23.5/1000 person-years) occurred in the tramadol cohort and 164 (13.8/1000 person-years) occurred in the naproxen cohort (rate difference, 9.7 deaths/1000 person-years [95% CI, 6.3-13.2]; hazard ratio [HR], 1.71 [95% CI, 1.41-2.07]), and mortality was higher for tramadol compared with diclofenac (36.2/1000 vs 19.2/1000 person-years; HR, 1.88 [95% CI, 1.51-2.35]). Tramadol was also associated with a higher all-cause mortality rate compared with celecoxib (31.2/1000 vs 18.4/1000 person-years; HR, 1.70 [95% CI, 1.33-2.17]) and etoricoxib (25.7/1000 vs 12.8/1000 person-years; HR, 2.04 [95% CI, 1.37-3.03]). No statistically significant difference in all-cause mortality was observed between tramadol and codeine (32.2/1000 vs 34.6/1000 person-years; HR, 0.94 [95% CI, 0.83-1.05]). Conclusions and Relevance: Among patients aged 50 years and older with osteoarthritis, initial prescription of tramadol was associated with a significantly higher rate of mortality over 1 year of follow-up compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but not compared with codeine. However, these findings may be susceptible to confounding by indication, and further research is needed to determine if this association is causal. |
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| 投稿者 | Zeng, Chao; Dubreuil, Maureen; LaRochelle, Marc R; Lu, Na; Wei, Jie; Choi, Hyon K; Lei, Guanghua; Zhang, Yuqing |
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| 組織名 | Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha,;Hunan, China.;Division of Rheumatology, Allergy, and Immunology, Department of Medicine,;Massachusetts General Hospital, Harvard Medical School, Boston.;Boston University School of Medicine, Boston, Massachusetts.;VA Boston Healthcare System, Boston, Massachusetts.;Clinical Addiction Research and Education Unit, Boston University School of;Medicine, Boston Medical Center, Boston, Massachusetts. |
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