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