Prescription Opioid Analgesic Use and Mortality in Systemic Lupus Erythematosus

Objectives: This research investigated the prevalence of opioid analgesic use in patients with systemic lupus erythematosus (SLE). Methods: This 5-year prospective cohort study of 275 SLE patients focused on prescription opioid use and 5-year outcome. Associations were determined with univariable regression analysis and then multivariable models were created to determine independent effects on dependent variables. Results: Prescription opioid use was common in SLE with 24% using opioid analgesics chronically and 76% not using opioids. Opioid users had a higher rate of tobacco use (p<0.01), cocaine use (p<0.002), mean pain scores (p<0.001), disease activity (SLEDAI-2K) (p<0.001), disease damage (SLICC/ACRDI) (p<0.001), non-adherence to medical therapy (p<0.01), and total deaths at 5 years (opioids: 48.0%, no opioids 19.0%, p<0.001). Logistic regression analysis predicting death revealed opioid use (hazard ratio 2.6, p<0.001) and SLEDAI-2K (1.1, p<0.001) respectively; and opioid use (hazard ratio 2.5, p<0.002), SLEDAI-2K (hazard ratio 1.1, p<0.001), and non-adherence (hazard ratio 1.6, p=0.11), respectively. Multivariable Cox Model analysis estimating probability of death with covariates: opioid use (hazard ratio 2.6, p<0.001) and SLEDAI-2K (hazard ratio 1.1, p<0.001); opioid use (hazard ratios 3.0, p<0.001), and cocaine use (hazard ratio 3.2, p<0.001). The Kaplan-Meir survival analysis revealed a significantly higher probability of death for SLE patients using opioid analgesics. Conclusions: Prescription opioid analgesic use is common in SLE and is associated with markedly increased mortality. Preferably, non-opioid approaches to treat chronic pain should be used in SLE patients.