Chronic opioid use in IBD tied to biologic discontinuation

Inflammatory bowel disease (IBD) patients with chronic opioid use are highly likely to discontinue their biologic therapy, according to a study. Furthermore, opioid withdrawal symptoms mimic IBD flares, leading to inappropriate switching of biologics and compromising disease control.

The study used data from the Truven MarketScan Database and included a cohort of 16,624 IBD patients initiating first‐line biologic treatment from 2011 to 2016. Of these, 1,768 patients were identified as chronic opioid users availing outpatient prescription claims.

Inpatient administration and outpatient claims data facilitated the assessment of usage patterns of biologic therapies, as well as healthcare utilization and common comorbidities. Chronic opioid users used a mean of 1.5 different biologic agents, which was significantly higher relative to the comparators (mean, 1.37; p<0.0001).

Of note, fewer patients in the chronic opioid use cohort persisted on biologic therapies to the end of the study period (16.2 percent vs 33.5 percent; p<0.0001).

Multivariable Cox regression analysis revealed that IBD patients who were also chronic opioid users had higher healthcare resource utilization and rate of comorbidities than the reference cohort. Chronic opioid use was associated with a 23-percent greater risk of being nonpersistent with biologic therapy (hazard ratio, 1.23, 95 percent confidence interval, 1.16–1.31), with the estimate obtained after accounting for relevant markers of disease acuity.