EULAR 2020 — OA: tramadol use tied to higher mortality risk than NSAIDs


  • Pavankumar Kamat
  • Conference Reports
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Takeaway

  • Patients with osteoarthritis (OA) treated with tramadol had a substantially higher mortality risk during the first year of treatment than those treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Tramadol users also had higher risks for cardiovascular disease (CVD), venous thromboembolism (VTE), and hip fractures than NSAID users.

Why this matters

  • The excess mortality risk with tramadol has been highlighted in previous studies; however, the comparison of risks for adverse events between tramadol and NSAIDs has been inconclusive. 

Study design

  • In a sequential propensity score-matched cohort study, researchers compared data on patients with a first prescription of tramadol (n=56,325), naproxen (n=13,798), diclofenac (n=17,675), cyclooxygenase-2 (COX-2) inhibitors (n=17,039), or codeine (n=7813).
  • Funding: None.

Key results

  • At 1-year follow-up, tramadol users had a higher mortality risk than users of naproxen (HR, 1.2), diclofenac (HR, 1.3), and COX-2 inhibitors (HR, 1.5) but not higher than codeine users (HR, 0.8).
  • Tramadol users had a higher risk for CVD than users of diclofenac (HR, 1.2) and COX-2 inhibitors (HR, 1.2).
  • Tramadol users had a higher 1-year risk for VTE than users of diclofenac (HR, 1.5) and COX-2 inhibitors (HR, 1.7).
  • Tramadol users also had a higher risk for hip fractures than users of naproxen (HR, 1.4), diclofenac (HR, 1.5), and COX-2 inhibitors (HR, 1.5).

Limitations

  • Observational design.

Expert commentary

Thomas Schwenk, MD, from the University of Nevada, Reno, said: "Tramadol might be an option for patients in whom NSAIDs are contraindicated, but it should be prescribed as judiciously as traditional opioids."