Wednesday, 22 May 2019

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Tramadol May be Associated with Increased Mortality in Osteoarthritis

JAMA reports that tramadol use in adults with osteoarthritis (OA) may be associated with increased all-cause mortality (compared with nonsteroidal anti-inflammatory drugs).

This cohort study included 88 902 adult patients (> 50 yrs) with osteoarthritis, and the outcome of those given an initial prescription of tramadol. Using data from a UK general practice database they specifically looked at outcomes in those exposed to tramadol (n = 44 451), naproxen (n = 12 397), diclofenac (n = 6512), celecoxib (n = 5674), etoricoxib (n = 2946), or codeine (n = 16 922).

During the 1-year follow-up, they recorded 278 deaths (23.5/1000 person-years) in the tramadol group and 164 (13.8/1000 person-years) occurred in the naproxen group (hazard ratio [HR], 1.71 [95% CI, 1.41-2.07]), and mortality was higher for tramadol compared with diclofenac (HR, 1.88), celecoxib (HR, 1.70) and etoricoxib (HR, 2.04). 

There was no significant difference in all-cause mortality observed between tramadol and codeine (HR, 0.94 [95% CI, 0.83-1.05]).

While the use of tramadol in OA was associated with a higher mortality rate c(ompared to NSAIDs). these findings may be susceptible to confounding by indication, and further research is needed.


The author has no conflicts of interest to disclose related to this subject

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