Tramadol May be Associated with Increased Mortality in Osteoarthritis Save

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.