New findings published in JAMA suggest tramadol may be associated with increased all-cause mortality compared with commonly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with osteoarthritis.
The sequential, propensity score-matched cohort study was 88,902 general practice patients in the United Kingdom aged 50 years and older with a diagnosis of osteoarthritis. Of the total cohort, 44,451 received an initial prescription of tramadol, while 12,397 received naproxen, 6512 received diclofenac, 5674 received celecoxib, 2946 received etoricoxib and 16,922 received codeine.
During one-year follow-up, 278 deaths occurred in the tramadol cohort compared to 164 (13.8/1000 person-years) in the naproxen cohort (HR, 1.71; 95% CI, 1.41-2.07). Mortality was also higher for tramadol compared with diclofenac (HR, 1.88; 95% CI, 1.51-2.35). Tramadol was also associated with a higher all-cause mortality rate compared with celecoxib (HR, 1.70; 95% CI, 1.33-2.17) and etoricoxib (HR, 2.04; 95% CI, 1.37-3.03).
No statistically significant difference in all-cause mortality was observed between tramadol and codeine (HR, 0.94; 95% CI, 0.83-1.05).
However, the authors state that the findings may be susceptible to confounding by indication and recommend further research to determine if this association is causal.