Initiation of Transdermal Fentanyl Among US Commercially Insured Patients Between 2007 and 2015.
Pain Med
; 21(10): 2229-2236, 2020 10 01.
Article
in En
| MEDLINE
| ID: mdl-32377671
ABSTRACT
INTRODUCTION:
This study examined patterns of initial transdermal fentanyl (TDF) claims among US commercially insured patients and explored the risk of 30-day hospitalization among patients with and without prior opioid exposure necessary to produce tolerance.DESIGN:
A retrospective cohort study of initial outpatient TDF prescriptions.SETTING:
A 10% random sample of commercially insured enrollees within the IQVIA Health Plan Claims Database (formerly known as PharMetrics Plus).SUBJECTS:
Individuals with a claim for TDF between 2007 and 2015.METHODS:
The primary exposure was a new transdermal fentanyl claim, and the primary outcome was guideline concordance based on time and dose exposure.RESULTS:
Among the 24,770 patients in the cohort, 4,848 (20%) patients had sufficient time exposure to opioids before TDF. Among those with sufficient time exposure, 3,971 (82%) had adequate opioid exposure based on the US Food and Drug Administration (FDA) package insert dosing guidance. Overall, 3,971 of the 24,770 (16%) patients received guideline-consistent TDF. An exploratory analysis of 30-day hospitalization after a TDF claim did not detect a difference in odds between guideline-consistent or -inconsistent groups when adjusted for variables known to influence the risk of opioid-induced respiratory depression.CONCLUSIONS:
A majority of patients met FDA opioid dose thresholds for TDF but had insufficient time exposure based on package insert recommendations for tolerance. Exploratory analysis did not detect a difference in odds for all-cause hospitalization or respiratory-related 30-day hospitalization between guideline-consistent or -inconsistent TDF claims. Prescribers should continue to adhere to FDA TDF labeling, although certain aspects of the labeling should be reevaluated or clarified.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Fentanyl
/
Analgesics, Opioid
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
Pain Med
Journal subject:
NEUROLOGIA
/
PSICOFISIOLOGIA
Year:
2020
Type:
Article