Abstract
ObjectiveTo investigate the prescription frequency of analgesics in persons diagnosed with rheumatoid arthritis (RA), axial spondylarthritis (axSpA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE) in 2019 using claims data.MethodsPersons ≥ 18 years insured in 2019 with a diagnosis of RA (M05, M06), axSpA (M45), PsA (M07.0-3) or SLE (M32.1,8,9) were included. Analgesics were identified by the anatomic therapeutic classification (ATC) system. Reported is the percentage of individuals with ≥ 1 analgesics prescription for the respective rheumatic diagnosis in 2019 and for opioids age-standardized in each of the years 2005–2019. In addition, the proportion of long-term opioid use (prescriptions in ≥ 3 consecutive quarter years) in 2006 and 2019 is compared.ResultsMetamizole (29–33%) was the most commonly prescribed analgesic. Nonsteroidal anti-inflammatory drugs (NSAID)/coxibs were prescribed from 35% (SLE) to 50% (axSpA). Of the patients 11–13% were prescribed weak and 6–8% strong opioids. From 2005 to 2019, the proportion of persons with an opioid prescription remained stable, with similar or slightly decreasing proportions of weak opioids and more frequent prescriptions of strong opioids. The proportion of long-term opioid prescriptions increased from 2006 to 2019 from 8.9% to 11.0% (RA), from 6.9% to 9.1% (axSPA), from 7.8% to 9.5% (PsA), and from 7.5% to 8.8% (SLE), corresponding to a 17–24% increase.ConclusionThe prescription of opioids for persons with inflammatory rheumatic diagnoses is not as high in Germany as in other countries; however, the proportion of long-term prescriptions has considerably increased. The frequent prescription of metamizole is conspicuous.
Highlights
Osteoarthritis was coded in 25% (SLE) to 43% (RA), osteoporosis in 14%
Metamizole was the most frequently prescribed step I analgesic: every third person diagnosed with rheumatoid arthritis (RA) and 30% of the insured persons diagnosed with systemic lupus erythematosus (SLE) received metamizole (
The gender distribution of the insured persons examined for RA and SLE corresponds to the expectations from the NDB; for axial spondylarthritis (axSpA) and psoriatic arthritis (PsA), there are more women among the insured persons
Summary
BARMER is one of the largest statutory health insurance companies in Germany with around 9 million insured persons nationwide. The ATC (Anatomical Therapeutic Chemical Classification System) codes of the substances are given in parentheses RA rheumatoid arthritis, axSpA axial spondyloarthritis, PsA psoriatic arthritis, SLE systemic lupus erythematosus afor ibuprofen, only the prescription portion is included (>400 mg) bfor paracetamol and acetylsalicylic acid, only the proportion of insured persons to whom a prescription was issued is included ciclosporin, cyclophosphamide, hydroxychloroquine, interleukin inhibitors, leflunomide, methotrexate, mycophenolate, ocrelizumab, rituximab, sulfasalazine, tumour necrosis factor (TNF)α inhibitors and tofacitinib. To examine trends in the prescription prevalence of opioids, the proportion of persons with at least one prescription of an opioid for the respective diagnosis was determined in each of the years 2005–2019, stratified according to weak (WHO step II: tilidine, tilidine + naloxone, tramadol) and strong opioids (WHO step III: oxycodone, oxycodone + naloxone, morphine, hydromorphone, fentanyl, buprenorphine) For this evaluation, the sample was standardised by age with the European standard population of 2013 [8], so that the age structure is comparable in all years.
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