High Burden and Phenotype-Specific Variability of Pain Polypharmacy in Early Autoimmune Rheumatic Diseases: A 15-Year...

Area of Science:

• Rheumatology
• Pain Management
• Pharmacology

Background:

• Pain significantly impacts disability and medication use in autoimmune rheumatic diseases (ARDs), irrespective of inflammation control.
• The prevalence of pain-related polypharmacy in ARDs, especially when co-occurring with chronic overlapping pain conditions (COPCs), is not well understood.

Purpose of the Study:

• To quantify the initial pain medication burden in the first year following an ARD diagnosis.
• To investigate how this medication burden varies based on specific ARD, presence of COPCs, and over time.

Main Methods:

• Utilized the Merative MarketScan Commercial Claims database (2008-2021).
• Identified adults with new diagnoses of rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, Sjögren's disease, or systemic sclerosis.
• Analyzed pain medication use across ten categories in the first year post-diagnosis, assessing polypharmacy using distinct medication counts, category counts, and thresholds (≥5, ≥10 medications).

Main Results:

• Of 149,742 ARD patients, 57.6% had a COPC.
• The mean number of distinct pain medications filled in the first year was 9.0.
• 47.9% of patients used ≥5 pain medications, and 30.5% used ≥10.
• Ankylosing spondylitis showed the highest burden (mean 11.6 medications).
• Fibromyalgia patients had higher medication burden across ARDs and were the only COPC group with increased prescribing post-2015.
• Overall medication burden increased from 2008 to 2014-2015 before declining, but remained high.

Conclusions:

• Pain-related polypharmacy is prevalent early in ARD diagnoses and is influenced by disease type and pain phenotype.
• Despite recent modest decreases, the high medication burden necessitates phenotype-specific, non-pharmacologic, and deprescribing approaches in rheumatology care.