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Opioid Usage and Diabetic Peripheral Neuropathy

Authors

Tim Casey

Fort Lauderdale—An analysis of a claims database found that 61% of patients with diabetic peripheral neuropathy (DPN) had not received treatment for the disease, although if patients took medications, they typically used opioids to manage the DPN. The authors also mentioned that nearly half of patients had a pain co-diagnosis.

Results were presented during a poster session at the AAPM meeting. The poster was titled Opioid Usage Among Patients with Diabetic Peripheral Neuropathy (DPN)—US Claims Database Analysis.

The authors noted that the International Association for the Study of Pain defines peripheral neuropathic pain in patients with diabetes as “pain arising as a direct consequence of abnormalities in the peripheral somatosensory system in people with diabetes.”

There are several first-line therapies available for these patients, including tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and anticonvulsants such as pregabalin and gabapentin. The authors said that most patients taking those drugs have side effects such as dizziness, somnolence, nausea, headache, blurred vision, and dry mouth.

In this analysis, the authors used the PharMetrics® Integrated Database to identify patients who were at least 18 years of age and had a diagnosis of DPN between January 1, 2009, and December 31, 2009. They included patients who had at least 12 months of continuous enrollment before and after the baseline date, which was defined as the date of the first DPN diagnosis.

If patients filled an opioid prescription in the 6 months before their baseline date, they were considered opioid experienced. If not, they were classified as opioid naïve. The authors further classified the opioid-experienced group based on the schedule of the drug (Schedule II and III/IV) as well as whether they were taking long-acting or short-acting opioids.

Of the 56,244 patients with DPN, mean age was 64 years and 51.8% were male. Approximately half were between 45 and 64 years of age. In addition, 27% of the patients were identified as opioid experienced.

The authors found that 49.6% of patients had at least 1 codiagnosis of pain, and opioid-experienced patients were more likely to have a pain-related codiagnosis. Of the total cohort, 36.5% had lower back pain (50.2% of opioid experienced and 31.3% of opioid naïve), 16.9% had back and neck pain (26.0% of opioid experienced and 13.5% of opioid naïve), 1.2% had post-herpetic neuralgia (1.3% of opioid experienced and 1.1% of opioid naïve), and 10.0% had cancer (10.5% of opioid experienced and 9.8% of opioid naïve). Other comorbidities were found in 16.8% of patients, including 22.7% of opioid-experienced patients and 14.6% of opioid-naïve patients.

At baseline, 61% of patients did not receive treatment for pain, including 50% of opioid-experienced patients and 70% of opioid-naïve patients. During the 12-month follow-up period, 59% of the patients had DPN-related treatment, including 91% of opioid-experienced patients and 47% of opioid-naïve patients.

Of the patients who received DPN-related treatment for their pain, 65% also took opioids, with most taking Schedule III/IV drugs. Further, 85% of opioid-experienced patients and 50% of opioid-naïve patients received opioids. For opioid-experienced patients, the most common drug class was antidepressants, while opioid-naïve patients were most likely to use Schedule III/IV opioids as monotherapy or in combination with other drugs.

For Schedule II short-acting opioids, the median time to discontinuation was 3 months in the opioid-experienced group and 2 months in the opioid-naïve group. Also, the median time to discontinuation was >12 months in the opioid-experienced group and 2 months in the opioid-naïve group for those taking Schedule II long-acting opioids. Finally, for Schedule III/IV opioids, the median time to discontinuation was 4 months in the opioid-experienced group and 2 months in the opioid-naïve group.

This poster was supported by Janssen Research & Development, LLC.

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