(P-192) Patient Characteristics, Pain Treatment Patterns, and Incidence of Total Joint Replacement in a Population with Osteoarthritis

Background: Many patients with osteoarthritis (OA) do not achieve adequate pain relief with currently available treatment options such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. There is a need to understand the characteristics, pain treatment patterns, and occurrence of total joint replacement (TJR) among patients with OA, as some of these patients are potential candidates for alternative treatments such as nerve growth factor inhibitors.

Objectives: To describe demographic and clinical characteristics of patients receiving pain medications for OA and estimate the incidence of TJR in these patients.

Methods: This retrospective, multi-center cohort study of adult patients with OA receiving pain medication included data from January 1, 2013, to December 31, 2019, from the Innovation in Medical Evidence Development and Surveillance Distributed Database (IMEDS-DD), a subset of the Sentinel System Network Data. Patient characteristics and pain treatment history were described for pain medication users, with index exposure being the first qualifying dispensing and by drug class including all qualifying treatment episodes with NSAIDs, opioids, or intra-articular (IA) steroids. Incidence rates (IRs) of TJR were estimated during a 7-year follow-up period for any pain medication users and during treatment episodes created by bridging consecutive dispensings <30 days apart for specific drug class users.

Results: Among 1,992,670 prevalent pain medication users, index pain medications were NSAIDs, 596,624 (29.9%); opioids, 1,161,806 (58.3%); IA steroids, 323,459 (16.2%). Mean (SD) age was 68.4 (12.3) years; 59.0% were female. Baseline comorbidities assessed during the year prior to index date included cardiovascular disease, 70.7%; diabetes, 27.5%; obesity, 19.0%; osteoporosis, 10.1%. Further, 20.6% used an NSAID following an opioid index dispensing, 62.6% had at least 1 prior opioid dispensing, and 3.6% had both NSAIDs and opioids dispensed on the index date. TJR IR per 100 person-years (95% CI) was 3.21 (3.20–3.23) among any pain medication users. IR by specific drug class was IA steroids, 8.05 (7.97–8.13); opioids, 7.45 (7.40–7.49); NSAIDs, 4.63 (4.58–4.67).

Conclusions: These OA patients were typically prescribed more than 1 pain medication over time, with opioids more commonly prescribed than NSAIDs and IA steroids. The IR of TJR was highest in patients receiving IA steroids and lowest in patients receiving NSAIDs.