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Long-acting opioid tied to increased risk of serious infections

07 Oct 2018

Patients using long-acting opioids with immunosuppressive properties are at greater risk of developing serious infections compared with those using the nonimmunosuppressive opioid counterpart, according to a study.

The study involved Tennessee Medicaid adult enrolees initiating long-acting opioids for pain. Infection risk was compared between individuals using long-acting opioids with known immunosuppressive properties (eg, morphine, fentanyl and methadone; n=61,240) and those using long-acting opioids without immunosuppressive properties (eg, oxycodone, oxymorphone and tramadol; n=22,811).

A total of 1,906 serious infections were identified during 55,663 person-years of follow-up (3.42 hospitalizations for serious infections per 100 person-years). The most common infection was pneumonia (56.1 percent), followed by cellulitis (17.9 percent), bacteraemia without pneumonia (15.3 percent), pyelonephritis (6.1 percent) and septic arthritis/osteomyelitis (3.8 percent).

Multivariate Poisson regression models showed that compared with nonimmunosuppressive opioid users, individuals using immunosuppressive opioids had a lower rate of serious infections (adjusted incidence rate ratio [aIRR], 0.78; 95 percent CI, 0.66–0.91).

Among individual opioids, oxycodone yielded the lowest risk of infection (aIRR, 0.73; 0.61–0.89). No significant differences in the infection risk were observed among other opioids and morphine.

The present data are consistent with results from animal and in-vitro experimental studies showing immunosuppressive properties only in certain opioids, researchers said. It is therefore important to carefully consider the risk of serious infections when making pain management decisions.

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