{"doi":"10.1007/s40801-025-00537-3","title":"Comparison of Opioid Utilization in Older Adults with Rheumatoid Arthritis before and after Initiating Biological or Targeted Synthetic Disease-Modifying Antirheumatic Drugs","abstract":"INTRODUCTION: Opioid use is common in rheumatoid arthritis (RA) for pain management; however, evidence of opioid-associated adverse events is increasing. While biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) improve functional outcomes such as pain, little is known about their impact on opioid utilization patterns. This study investigated opioid utilization before and after b/tsDMARD initiation and assessed effect modification by sex. METHODS: Using 5% Medicare claims data from 2012 to 2020, this cohort study included older adults (≥ 65 years) with RA who initiated b/tsDMARDs (first prescription = index date), and had continuous Medicare Parts A, B, and D, but not Part C enrollment, during 12 months before and after initiation. The outcomes of interest were any opioid use and long-term opioid therapy (LTOT). McNemar's test was performed to compare outcomes before and after b/tsDMARD initiation. Sex-based differences in changes in opioid use after b/tsDMARD initiation were also evaluated. RESULTS: The study cohort included 3585 individuals with RA initiating b/tsDMARDs; most were female (75.87%) with a mean (SD) age of 73.15 (5.99) years. Following b/tsDMARD initiation, any opioid use decreased significantly from 2094 (58.41%) to 2017 (56.26%) (p = 0.015). However, LTOT use increased significantly from 733 (20.45%) to 900 (25.10%) (p < 0.001), following b/tsDMARD initiation. No evidence of sex differences in the association between b/tsDMARD initiation and opioid utilization was identified. CONCLUSIONS: Initiating b/tsDMARDs was associated with a modest reduction in any opioid use. However, LTOT use in RA remained persistently high. The impact of different b/tsDMARD initiation on opioid utilization patterns needs further investigation.","journal":"Drugs - Real World Outcomes","year":2025,"id":587013,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9614,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1502149,"name":"Shadi Bazzazzadehgan","orcid":"0000-0002-1407-4727","position":1,"is_corresponding":false},{"id":1502150,"name":"Liang-Yuan Lin","orcid":"0000-0003-3679-2209","position":2,"is_corresponding":false},{"id":1502504,"name":"Omkar Ghodke","orcid":null,"position":3,"is_corresponding":false},{"id":966925,"name":"Sebastian Bruera","orcid":"0000-0003-3027-9287","position":4,"is_corresponding":false},{"id":306932,"name":"Kaustuv Bhattacharya","orcid":"0000-0003-0518-5879","position":5,"is_corresponding":false},{"id":1502151,"name":"Sujith Ramachandran","orcid":"0000-0002-8792-4307","position":6,"is_corresponding":false},{"id":1120002,"name":"John P. Bentley","orcid":"0000-0002-9241-6833","position":7,"is_corresponding":false},{"id":819011,"name":"Sandeep K. Agarwal","orcid":"0000-0002-0053-2803","position":8,"is_corresponding":false},{"id":728699,"name":"Y. Yang","orcid":"0000-0001-8320-927X","position":9,"is_corresponding":false},{"id":1305784,"name":"Yinan Huang","orcid":"0000-0002-9579-4119","position":0,"is_corresponding":true}],"reference_count":48,"raw_metadata":null,"created_at":"2026-07-19T02:59:36.020030Z","pmid":"41442071","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}