Objective This study compared opioid utilization trajectories of persons initiating tramadol, short-acting hydrocodone or short-acting oxycodone, and characterized opioid dose trajectories and type of opioid in persistent opioid therapy sub-samples. Methods A retrospective cohort study of adults with chronic non-cancer pain initiating opioid therapy was conducted using the IQVIA PharMetrics® Plus for Academics data (2008–2018). Continuous enrollment was required for 6 months before (baseline) and 12 months after (follow-up) the first opioid prescription (index date). Opioid therapy measures were assessed every 7 days over follow-up. Group-based trajectory modeling (GBTM) was used to identify trajectories for any opioid and total morphine milligram equivalent (MME) measures, and longitudinal latent class analysis (LLCC) was used for opioid therapy type. Results A total of 40,276 tramadol, 141,023 hydrocodone and 45,221 oxycodone initiators were included. GBTM on any opioid therapy identified three latent trajectories: Early discontinuers (tramadol-39.0%, hydrocodone-54.1%, oxycodone-61.4%), late discontinuers (tramadol-37.9%, hydrocodone-39.4%, oxycodone-33.3%), and persistent therapy (tramadol-6.7%, hydrocodone-6.5%, oxycodone-5.3%), and an additional fourth trajectory, intermittent therapy (tramadol-16.4%), was identified for tramadol initiators. There were 2,687, 9,169, and 2,377 individuals with persistent therapy for tramadol, hydrocodone and oxycodone respectively. GBTM on opioid dose resulted in six similar trajectory groups in each persistent therapy group. LLCC on opioid therapy type identified six latent classes for tramadol and oxycodone and seven classes for hydrocodone. Conclusion Opioid therapy patterns meaningfully differed depending on the initial opioid prescribed, notably the presence of intermittent therapy among tramadol initiators, and higher MME and prescribing of long-acting opioids among oxycodone initiators.

中文翻译：

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开始短效阿片类药物制剂后一年随访中慢性非癌性疼痛患者的阿片类药物治疗轨迹

目的 本研究比较了开始使用曲马多、短效氢可酮或短效羟考酮的人的阿片类药物使用轨迹，并描述了持续阿片类药物治疗子样本中阿片类药物的剂量轨迹和类型。方法 使用 IQVIA PharMetrics® Plus 学术数据（2008-2018 年）对患有慢性非癌症疼痛的成人开始阿片类药物治疗进行回顾性队列研究。需要连续登记第一个阿片类药物处方前 6 个月（基线）和后 12 个月（随访）（索引日期）。随访期间每 7 天评估一次阿片类药物治疗措施。基于组的轨迹模型（GBTM）用于识别任何阿片类药物和总吗啡毫克当量（MME）测量的轨迹，纵向潜在类别分析（LLCC）用于阿片类药物治疗类型。结果 共纳入 40,276 种曲马多、141,023 种氢可酮和 45,221 种羟考酮引发剂。任何阿片类药物治疗的 GBTM 都确定了三种潜在轨迹：早期停药（曲马多 - 39.0％、氢可酮 - 54.1％、羟考酮 - 61.4％）、晚期停药（曲马多 - 37.9％、氢可酮 - 39.4％、羟考酮 - 33.3％）和持续停药治疗（曲马多 - 6.7％，氢可酮 - 6.5％，羟考酮 - 5.3％），以及额外的第四个轨迹，间歇性治疗（曲马多 - 16.4％），被确定为曲马多起始剂。分别有 2,687、9,169 和 2,377 人持续接受曲马多、氢可酮和羟考酮治疗。阿片类药物剂量的 GBTM 在每个持续治疗组中产生了六个相似的轨迹组。LLCC 关于阿片类药物治疗类型确定了六类潜在的曲马多和羟考酮以及七类潜在的氢可酮。结论 阿片类药物治疗模式根据初始阿片类药物处方的不同而存在显着差异，特别是曲马多起始剂中存在间歇性治疗，以及羟考酮起始剂中较高的 MME 和长效阿片类药物处方。