Osteoarthritis: tramadol tied to higher mortality than NSAIDs

  • Zeng C & al.
  • JAMA
  • 12 Mar 2019

  • International Clinical Digest
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Takeaway

  • Initial prescription of tramadol (Ultram) for osteoarthritis (OA) is associated with at least a 70% higher all-cause mortality in the first year than commonly used NSAIDs, but not codeine.

Why this matters

  • Several sets of clinical practice guidelines recommend tramadol as a first-line therapy for knee OA.
  • Before reconsidering these guidelines, confirmatory research is necessary.
  • Tramadol was previously linked to a higher risk for falls and postoperative delirium.

Study design

  • Sequential, propensity-matched cohort study of 88,902 patients aged ≥50 years with knee, hip, or hand OA at general practices in the United Kingdom, as reported to the Health Improvement Network electronic medical records database (2000-2015).
  • Funding: NIH; National Natural Science Foundation of China.

Key results

  • Tramadol vs naproxen: rate difference, 9.7 deaths/1000 person-years; HR, 1.71; 95% CI, 1.41-2.07.
  • Tramadol vs diclofenac: rate difference, 17.0 deaths/1000 person-years; HR, 1.88; 95% CI, 1.51-2.35.
  • Tramadol vs celecoxib: rate difference, 12.8 deaths/1000 person-years; HR, 1.70; 95% CI, 1.33-2.17.
  • Tramadol vs etoricoxib: rate difference, 12.8 deaths/1000 person-years; HR, 2.04; 95% CI, 1.37-3.03.
  • Tramadol vs codeine: rate difference, −2.3 deaths/1000 person-years; HR, 0.94; 95% CI, 0.83-1.05.

Limitations

  • Cause of death not captured in up to 30% of cases.
  • Potential confounding by indication.
  • Retrospective, observational design.