[Cập nhật] Risk of increased NSAID allergy for Opioid abuse in Osteoarthritis ACAAI 2020


According to a 5-year retrospective analysis, patients with osteoarthritis and allergy to nonsteroidal anti-inflammatory drugs (NSAIDs) were more likely to develop opioid addiction than patients without allergies.

“In fact, the risk of opioid addiction in people with an NSAID allergy is twice as high as in people without an allergy.” “We found that NSAID allergy may be an important risk factor for opioid use disorder,” said Investigator Lily Li, MD, from Brigham and Women’s Hospital in Boston.

“But it seems that not all of the reactions reported in the electronic health records indicate that the patient is ‘really hypersensitive’ or allergic, she said in her presentation at the Society of Medicine. Annual Scientific Conference on Allergy, Asthma & Immunology 2020, where the oral abstract won second place in the Clemens von Pirquet Prize.

“More than 80% of the reported reactions were actually thought to represent non-allergic and intolerance side effects,” explains Li. When tested in the lab, “we know that a confirmatory drug challenge is usually negative,” she added. “Many patients labeled as allergic to NSAIDs can actually tolerate NSAIDs.” Many patients labeled as allergic to NSAIDs can actually tolerate NSAIDs.

Li and her colleagues assessed the risk of opioid addiction in patients with NSAID-allergic osteoarthritis because opioids are often prescribed to patients with a history of NSAID allergy.

“The opium epidemic remains a pressing health problem,” she said. More than 2 million Americans are addicted to opioids, and “seven out of ten opioid prescriptions are prescribed for physical pain.” This is contrary to the fact that NSAIDs are indicated by the World Health Organization for the treatment of musculoskeletal pain.

The team searched the electronic health records of adults with osteoarthritis treated at a tertiary care center between January 2013 and December 2018 and identified 15,682 patients with osteoarthritis. osteoarthritis. Of these, 1442 (9.2%) patients had 1856 NSAID reactions recorded in the allergies tab of their electronic health record.

The most commonly reported reaction was with aspirin (25.6%), followed by ibuprofen (12.6%), naproxen (11.5%), celecoxib (5.7%) and “other NSAIDs.” (7.4%). Reactions to NSAIDs “as a” were reported in 22.3% of cases, and reactions to other NSAIDs – namely indomethacin, rofecoxib, diclofenac, nabumetone and ketorolac – were reported in less than 5% of cases. .

This is an indication that further testing may be required to confirm an NSAID allergy. “The high rate of ‘unknown’ or ‘other’ reactions highlights the challenges in assessing and caring for patients with a history of ambiguous reactions,” says Li. “This needs to be clarified.” Higher rates of opioid use disorders.

In 1442 patients there was a composite documented reaction with 5766 patients with documented non-NSAID allergy with underlying medical conditions, including cardiovascular disease, renal failure, connective tissue disease, peptic ulcer disease. colon, anxiety, depression, malignancy, chronic urticaria, allergic rhinitis, asthma and atopic dermatitis.

When NSAID response patients were compared with 14,240 patients in the documented nonallergic osteoarthritis cohort, NSAID response was shown to significantly increase the incidence of opioid use disorder. (ratio of difference [OR], 2.09).

Opioid use disorder was also higher in the NSAID-responsive group compared with the non-NSAID-allergic propensity matched group (OR, 1.56). In multivariable regression models adjusted for patient baseline characteristics, patients who responded to NSAIDs were still more likely to have an opioid use disorder than those in the osteoarthritic cohort who did not. literature on NSAID allergy (OR, 1.70) and than in those without NSAID allergy (OR 1.53).

“This supports our hypothesis,” Li confirmed. Other factors also increase the risk of developing an opioid use disorder, including younger age, being male, depression, or asthma.” NSAID response increases opioid prescription rates (OR, 1.23 ), but reduced the prescribing rate of celecoxib (OR, 0.77). “This suggests over-prescribing of opioids and over-prescribing of celecoxib,” explains Li.

“Although celecoxib is considered an NSAID,” she notes, due to its selectivity as a cyclooxygenase-2 inhibitor. [COX-2], it has very little cross-reactivity with non-selective NSAIDs. It can almost always be used safely, even in patients with hypersensitivity to nonselective NSAIDS. “Overdiagnosis of drug allergy is an important clinical – but also social and economic – problem.

“Overdiagnosis of drug allergy is a clinical – but also social and economic – problem,” says Marek L. Kowalski, MD, PhD, from Lodz Medical University in Poland. The increased frequency of opioid prescriptions, Kowalski told Medscape Medical News, is probably due to avoidance of all NSAIDs, which are first-line pain relievers in osteoarthritis patients. “Awareness about NSAID labeling is important because a significant proportion of these patients, possibly up to 50%, are not actually allergic to NSAIDs.”

Kowalski said he agrees that an alternative pain reliever can be prescribed. “A well-trained allergist can offer an alternative pain reliever that will be well tolerated by the patient, thereby reducing overall opioid use.”

American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting 2020 Summary A003.

According to ACAAI 2020.

Source: https://www.medscape.com/viewarticle/941443#vp_1



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