Adherence to Disease-Modifying Drugs Lowers Chronic Opioid Use in Patients with Inflammatory Conditions

Gail Bridges

Patients who are adherent to prescribed biologic disease-modifying anti-rheumatic drugs (bDMARDs) tend to have lower rates of chronic opioid use, according to a new study of more than 1,500 patients.

The findings suggest specialty pharmacies might be able to cut down reliance on opioids if they are able to boost compliance among patients taking bDMARDs. The findings were slated to be presented at the Academy of Managed Care Pharmacy’s 2020 meeting. The in-person event was canceled because of the COVID-19 outbreak but presentations were made online and the abstracts of research findings made available.  

Many patients with inflammatory conditions have found that their disease is successfully controlled with bDMARDs, a group of biologics that includes abatacept, etanercept, infliximab, and others. However, some patients continue to use opioids for pain management before and during their treatment with these biologics. While such opioid use might theoretically be helpful for short periods of time, pharmacists and public health officials worry about the significant risk of opioid misuse, fraud, and abuse.

Investigators from Express Scripts and its specialty pharmacy, Accredo Health Group, sought to better understand the factors at play in chronic opioid use among patients taking bDMARDs. More specifically, they wanted to know if patients who stuck with bDMARD therapy as prescribed were less likely to be chronic users of opioids. In addition, they looked at whether the  “pharmacy channel” by which the patient filled his or her prescription affected chronic opioid use.

The authors set up a retrospective, matched, case-controlled study using pharmacy and medical claims. The data set included 1,562 patients who were commercially insured, were between the ages of 18 and 62, and had an inflammatory condition diagnosis between 2015 and 2017. The patients were stratified based on where they filled the majority (75% or more) of their bDMARD prescriptions: through the Accredo specialty pharmacy, an outside specialty pharmacy, or a retail pharmacy. Patients were defined as “chronic” opioid users if they had continuous use of 90 days or more.

Study co-author Gail Bridges, Pharm.D., director of specialty clinical product at Accredo, said the data show bDMARDs are effective at corralling inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis, and Crohn’s disease.

“Patients who are adherent to their therapy are more likely to have their condition under optimal control,” she told Managed Healthcare Executive®. “Successful disease control leads to less pain, inflammation or disease flares; hence less need for pain medications.”

According to a multivariate analysis, patients who were adherent to their bDMARD were 27% less likely to be a chronic opioid user. On the other hand, the study did not find significant links between the location where a patient picked up a prescription and the extent of the patient’s opioid use.

Overall opioid use among the three channels varied little, ranging from between 48.1% and 49.8%. Similarly, the rate of chronic opioid use was around 15% regardless of where patients filled the prescription.

Pharmacy channel did make a statistically significant difference, though, in terms of bDMARD adherence. The data showed adherence rates were 71.3% among patients who used Accredo’s pharmacy, compared to 65.9% at other specialty pharmacies and 65% at retail pharmacies.

Bridges said Accredo provides custom clinical protocols designed to help physicians with drug education, adherence coaching, and barrier screening and mitigation. She credits that model with helping to boost adherence rates.

The study’s authors conclude that both physicians and specialty pharmacists have a role to play in boosting patient adherence when a bDMARD is indicated. Though the drugs come with a high price tag, the authors say patients who successfully use the medications have a lower risk of opioid use, which in turn has benefits for patients, the healthcare system, and the broader society.