Hyman Professor of Medicine and Chief, Division of Gastroenterology University of Tennessee Health Science Center Memphis, TN
Colin Howden, MBChB1, Douglas Taylor, MBA2, Krutika Jariwala-Parikh, PhD3, Joseph Tkacz, MS3; 1University of Tennessee Health Science Center, Memphis, TN; 2Ironwood Pharmaceuticals, Boston, MA; 3IBM Watson Health, Bethesda, MD
Introduction: Despite the efficacy of proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD), many patients are dissatisfied and report persistent symptoms. Refractory GERD (rGERD), defined as the continuation of heartburn and regurgitation in the presence of PPI therapy, may lead patients to explore other treatment options. Long-term opioid use and the risk for addiction are well documented. Little is known about opioid use among GERD patients. As part of a study of U.S. rGERD and non-rGERD patients, we assessed their opioid use. Methods: This retrospective analysis of the IBM MarketScan databases of commercial and Medicare supplemental claims, 1/1/2011 to 6/30/2017, included patients with: prescription fill for a PPI or H2-receptor antagonist (index date =earliest claim); a claim with a diagnosis code for GERD within 60 days of index; ≥2 refills of the index medication or baclofen; continuous insurance enrollment for 12 months pre- and post-index; absence of GERD diagnosis in first 305 days of the pre-index year; and absence of GERD medications (including baclofen) in the prior year. Patients were identified as rGERD or non-rGERD based on a previously published claims-based algorithm examining specific treatment-based outcomes post-index (medication switching, surgical interventions, etc.). The proportion of patients filling opioid prescriptions was examined across groups and among those with abdominal pain. Results: Of 399,017 GERD patients, 103,576 (26%) had rGERD; 49.7% of rGERD patients reported abdominal pain, vs 22.7% of non-rGERD (P < 0.01; Figure 1). Patients with rGERD were more likely to fill an opioid prescription vs. non-rGERD (46.9% vs. 35.1%; P < 0.01); approximately 80% of patients filling opioid prescriptions across both GERD cohorts filled >30 days’ supply over the follow-up year. The proportion of patients with both opioid use and comorbid abdominal pain was greater in the rGERD group compared to non- rGERD (26.7% vs. 10.6%; P < 0.01). Discussion: Opioid use was substantial among patients with GERD and was significantly higher among those with rGERD. Although abdominal pain was more prevalent in rGERD patients, this does not entirely explain their greater use of opioids. The high prevalence of both abdominal pain and opioid use among rGERD patients further emphasizes the symptom burden faced by these patients. Further study of the characteristics of rGERD patients and their concomitant health issues is warranted.
Opioid Use and Abdominal Pain
Disclosures: Colin Howden: Ironwood Pharmaceuticals – Consultant. Douglas Taylor: Ironwood Pharmaceuticals – Employee. Krutika Jariwala-Parikh: Ironwood Pharmaceuticals – Consultant. Joseph Tkacz: Ironwood Pharmaceuticals – Consultant.