トラマドールと関節炎患者の全因死亡率との関連
Chao Zeng1,2, Maureen Dubreuil3,4, Marc R LaRochelle5
1Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
JAMA
|March 13, 2019
まとめ
トラマドールの処方薬は,NSAIDと比較して死亡率の増加と関連していたが,コデインはそうではなかった. この関連が因果的かどうかを確認するには,さらなる研究が必要である.
科学分野:
- ゲロントロジー
- 薬理学について
- 流行病学
背景:
- ガイドラインでは,膝関節炎の治療にトラマドールを推奨し,NSAIDと併用して第一線療法として推奨する人もいます.
- 骨格関節炎は 何百万もの患者に 影響を及ぼし 効果的な痛み管理戦略が必要になります
研究 の 目的:
- トラマドール処方と全因死亡率の関連性を調べる
- トラマドールと他の一般的な鎮痛剤の死亡リスクを比較する.
主な方法:
- 2000年から2016年のイギリスの一般的な実務データを用いて,連続した傾向スコアマッチングのコホート研究を行いました.
- トラマドールとナプロキセン,ディクロフェナック,セレコキシブ,エトリコキシブ,またはコデインを処方された患者を比較した.
主要な成果:
- トラマドールはナプロキセン,ディクロフェナック,セレコキシブ,エトリコキシブと比較して1年以内に死亡率が著しく高かった.
- トラマドールとコデインの使用者間で死亡率の有意な差は認められなかった.
- この研究では,平均年齢が70. 1歳の患者88, 902人が参加しました.
結論:
- トラマドールの初期処方箋は,NSAIDと比較して,骨格関節炎の死亡率の増加と相関しています.
- 観察された関連は,混同要因によって影響され,因果関係をさらに調査する必要があります.
- トラマドールのリスクと効果を骨格関節炎の管理において慎重に検討することを示唆しています.
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