TOPLINE:

Opioid prescription rates in patients with axial spondyloarthritis (axSpA) remained stable in the UK from 2001 to 2020 but declined in the US after 2016. TNF inhibitor prescriptions increased in the US over two decades.

METHODOLOGY:

• Researchers conducted an ecological study to examine trends in annual prescription rates for opioids in adults with axSpA in the UK and the US.
• They analyzed data from two observational data sources spanning two decades: an electronic medical record-based database from the UK (IQVIA Medical Research Database) from 2000 to 2020 and a claims-based database from the US (MarketScan) from 2006 to 2021.
• A total of 1689 patients from the UK (mean age, 47 years; 74% men) and 18,858 patients from the US (mean age, 45 years; 51% men), all meeting axSpA criteria, were included, with median follow-up durations of 5.6 years and 1.7 years, respectively.
• Annual prescription rates, expressed as prescriptions per person-year, were calculated using joinpoint regression for opioids (including tramadol and topical fentanyl), with nonsteroidal anti-inflammatory drugs (NSAIDs) and TNF inhibitors (in US only) as comparators.
• The annual percent change and average annual percent change were calculated to provide a comprehensive overview of prescription trends across the study period.

TAKEAWAY:

• In the UK, opioid prescription rates for axSpA showed a nonsignificant annual decrease of 2.5% from 2001 to 2007, followed by a 3.9% increase from 2007 to 2016 and a near-stable declining trend from 2016 to 2020.
• The average annual percent change for opioids in the UK showed a significant increase of 0.9% from 2001 to 2020, whereas it showed a significant decrease of 3.9% for NSAIDs.
• In the US, opioid prescription rates showed a nonsignificant annual decrease from 2008 to 2016, followed by a significant annual decline of 8.6% from 2016 to 2021.
• The average annual percent change for opioids in the US showed a significant decrease of 4.3% from 2008 to 2021, with the average annual percent change for NSAIDs decreasing by 1.1% and for TNF inhibitors increasing by 1.8%.

IN PRACTICE:

“Our findings highlight that despite increased TNFi [TNF inhibitor] use over the past two decades, opioid prescribing trends have remained stable in the UK and only modestly declined in the US, likely due to national opioid prescribing policies rather than biologic uptake. These results underscore the need for continued efforts to better understand and address persistent opioid use in axSpA, even in the context of improved disease-modifying treatment options,” the authors wrote.

SOURCE:

The study was led by Berk Degirmenci, MD, Boston University Chobanian & Avedisian School of Medicine in Boston. It was published online on September 22, 2025, in Arthritis Care & Research.

LIMITATIONS:

MarketScan did not include individuals without commercial insurance, limiting generalizability to the entire US population, while UK database lacked information on biologic prescriptions. Misclassification of axSpA based on diagnostic codes may be possible, potentially affecting disease prevalence estimates. Over-the-counter use of NSAIDs could not be assessed accurately in both the databases.

DISCLOSURES:

This study was supported by the National Institutes of Health (NIH). Several authors reported receiving grants from sources, including the National Institute for Health Research, the Rheumatology Research Foundation, NIH, and others. Some authors reported receiving grants or contracts, consulting fees, or having other ties with various organizations and/or pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.