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Asociación del tramadol con la mortalidad por todas las causas entre los pacientes con osteoartritis
Chao Zeng1,2, Maureen Dubreuil3,4, Marc R LaRochelle5
1Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
JAMA
|March 13, 2019
Resumen
Las prescripciones de tramadol para la osteoartritis se relacionaron con un aumento de la mortalidad en comparación con los AINE, pero no con la codeína. Se necesita más investigación para confirmar si esta asociación es causal.
Área de la Ciencia:
- Gerontología
- Farmacología
- Epidemiología
Sus antecedentes:
- Las directrices recomiendan el tramadol para la osteoartritis de rodilla, y algunas lo recomiendan condicionalmente como terapia de primera línea junto con los AINE.
- La osteoartritis afecta a millones de personas y requiere estrategias eficaces para controlar el dolor.
Objetivo del estudio:
- Investigar la asociación entre la prescripción de tramadol y la mortalidad por cualquier causa en pacientes con osteoartritis.
- Para comparar el riesgo de mortalidad de tramadol con otros analgésicos comunes.
Principales métodos:
- Un estudio secuencial de cohorte con puntuación de propensión utilizó datos de práctica general del Reino Unido de 2000-2016.
- Se incluyeron pacientes mayores de 50 años con osteoartritis, comparando a los usuarios de tramadol con aquellos a los que se les había prescrito naproxeno, diclofenaco, celecoxib, etoricoxib o codeína.
Principales resultados:
- El tramadol se asoció con una mortalidad por todas las causas al año significativamente mayor que el naproxeno, el diclofenaco, el celecoxib y el etoricoxib.
- No se encontró ninguna diferencia significativa en la mortalidad entre los usuarios de tramadol y codeína.
- El estudio incluyó a 88.902 pacientes, con una edad media de 70,1 años.
Conclusiones:
- La prescripción inicial de tramadol en adultos mayores con osteoartritis se correlacionó con un aumento de la mortalidad en comparación con los AINE.
- La asociación observada puede estar influenciada por factores de confusión, lo que requiere una mayor investigación de la causalidad.
- Los hallazgos sugieren una cuidadosa consideración de los riesgos frente a los beneficios del tramadol en el tratamiento de la osteoartritis.
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