Please refer to the full Prescribing Information at CIMZIAhcp.com.
The 2015 treatment guidelines for active ankylosing spondylitis (AS) and nr-axSpA support non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy as the first-line management approach. The guidelines strongly recommend against systemic steroids in these patients. For patients whose disease remains active despite NSAIDs and physical therapy, anti-tumor necrosis factor (TNF) therapy is recommended as the first-line biologic.1 Slow-acting anti-rheumatic drugs (SAARDs), such as sulfasalazine, are recommended only for patients who experience peripheral arthritis.1
Opioids are commonly prescribed for pain in patients with axSpA (including those with nr-axSpA), even though these medications do not address the underlying inflammation of the disease. In a study of a commercial claims database from 2012 to 2017, 27.3% of patients with diagnostic code 720.x were classified as chronic opioid users.2,* While there is no International Classification of Diseases (ICD) code specific for nr-axSpA, the 720.x code may encompass various presentations of spondyloarthropathy, including patients with AS and nr-axSpA. In this study, 43.3% of chronic opioid users were not receiving concomitant therapy with an NSAID or anti-TNF, indicating that they were likely using an opioid alone to treat their disease symptoms.2
*Data included for all chronic opioid users (n = 21,590) in the 12-month follow-up period. Chronic opioid use defined as ≥90 cumulative days of opioid use. Concomitant medication use was defined as a claim made within ± 30 days of an opioid claim. Limitations of claims data include reliance on accurate diagnostic coding and exclusion of patients with commercial insurance. The indication for which opioids were prescribed, opioid potency and dosage were not included in the analysis. Use of over-the-counter NSAIDs was not captured. Additional limitations include broad ICD9 code (720.x) use which may result in the capture of other axial arthritic diseases and inclusion of false positive cases.
1. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-298.
2. Sloan VS, Sheahan A, Stark J, Suruki RY. Opioid Use in Patients with Ankylosing Spondylitis is Common in the United States: Outcomes of a Retrospective Cohort Study. J Rheumatol. 2019;46(4):1-30.
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Version: August 2019
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