Regular use of acetaminophen or acetaminophen-codeine combinations and prescription of rescue therapy with non-steroidal anti-inflammatory drugs: a population-based study in primary care.
There are contrasting positions concerning the benefit-risk ratio of acetaminophen use for osteoarthritis (OA)-related pain. To clarify the effectiveness of acetaminophen or acetaminophen-codeine combinations according to their regimen of use, we evaluated whether being a regular user (adherent) of these medications decreased the occurrence of rescue therapy with non-steroidal anti-inflammatory drugs (NSAIDs).



Using the Health Search IMS Health Longitudinal Patient Database, we formed a cohort of patients aged ≥18 years and newly treated with acetaminophen or acetaminophen-codeine combinations for OA between 1 January 2001 and 31 December 2013. These patients were followed up for one year in which they were categorized as regular or irregular users of these medications according to a variable medication possession ratio (VMPR) ≥ 50% or lower. We operationally defined the rescue therapy as the use of any NSAIDs prescribed for OA-related pain.



Overall, 40,029 patients (69.5% females; mean age: 68 ± 13.57) treated with acetaminophen or acetaminophen-codeine combinations formed the cohort. After the first year of treatment, regular users showed a statistically significantly lower risk of being prescribed with rescue therapy with NSAIDs (OR = 0.89; 95% CI 0.84-0.96).



These findings show that regular use of acetaminophen or acetaminophen-codeine combinations may reduce the need for NSAIDs to treat OA-related pain.
a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy.
Alfredo
A
Vannacci
a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy.
Niccolò
N
Lombardi
b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy.
Monica
M
Simonetti
c Department of Medical Biotechnology and Translational Medicine , University of Milan , Milan , Italy.
Diego
D
Fornasari
d Unit of Anaesthesiology and Pain Therapy , General Hospital S. Orso Malpighi, University Hospital of Bologna , Bologna , Italy.
Andrea
A
Fanelli
b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy.
Iacopo
I
Cricelli
e Italian College of General Practitioners and Primary Care , Florence , Italy.
Claudio
C
Cricelli
e Italian College of General Practitioners and Primary Care , Florence , Italy.
Pierangelo
P
Lora Aprile
b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy.
Francesco
F
Lapi
D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003061:Codeine / Q000008:administration & dosage*; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010003:Osteoarthritis / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*; D011320:Primary Health Care; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; D000082:Acetaminophen; D003061:Codeine
Acetaminophen; acetaminophen–codeine; adherence; osteoarthritis; pain; primary care