PT - JOURNAL ARTICLE AU - L. LI AU - N. Lu AU - H. Xie AU - J. Cibere AU - J. Kopec AU - J. Esdaile AU - J. A. Aviña-Zubieta TI - OP0191 ASSOCIATION OF TRAMADOL WITH ALL-CAUSE MORTALITY, CARDIOVASCULAR DISEASE, VENOUS THROMBOEMBOLISM AND HIP FRACTURES AMONG PATIENTS WITH OSTEOARTHRITIS. A POPULATION-BASED STUDY AID - 10.1136/annrheumdis-2020-eular.1889 DP - 2020 Jun 01 TA - Annals of the Rheumatic Diseases PG - 118--119 VI - 79 IP - Suppl 1 4099 - http://ard.bmj.com/content/79/Suppl_1/118.1.short 4100 - http://ard.bmj.com/content/79/Suppl_1/118.1.full SO - Ann Rheum Dis2020 Jun 01; 79 AB - Background: Both tramadol (narcotic-like drug) and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for pain relief among osteoarthritis (OA) patients. Evidence comparing risks of adverse events between tramadol and NSAIDs users is inconclusive.Objectives: To examine the association of tramadol with all-cause mortality, cardiovascular disease (CVD), venous thromboembolism (VTE) and hip fractures (HFx) compared with NSAIDs and codeine in OA.Methods: Design: Sequential propensity score-matched cohort study. Sample: All patients with OA who received medical care from 2005 to 2014 in the entire province of British Columbia, Canada. Tramadol cohort: Initial prescription of tramadol (n=56325). Four comparator cohorts: the initiation of one of the following: naproxen (n=13798), diclofenac (n=17675), cyclooxygenase-2 [Cox-2] inhibitor (n= 17039), or codeine (a weak opioid) (n=7813). Patients required to be prescribed neither tramadol nor its comparators during the year before the initial prescription date (i.e., index date). Outcomes: 1) all-cause mortality; first ever2) CVD, 3) VTE, 4) HFx within the 1st year after the initiation of tramadol or its comparators. Follow-up: from index date until the event occurred, disenrollment, or the end of a 1-year follow-up period. Statistical analysis: We created baseline covariates (demographics, comorbidities, medications and health resource utilization) from the year prior to the index date. Calendar years from 2005 to 2014 were divided into 10 blocks; propensity scores were calculated using logistic regression within each block. We used 1:1 greedy matching method. We estimated hazard ratios (HRs) using Cox proportional hazard models.Results: After propensity score matching, 112650 patients with OA were included (mean age of 68 years, 62.8% were females). During the 1-year follow-up, 296 deaths (21.5/1000 person-years) occurred in the tramadol cohort and 246 (17.8/1000 person-years) in the naproxen cohort (Table 1). All-cause mortality was higher for tramadol compared with all NSAIDs cohorts, but not with the codeine cohort (Table 1, Figure 1). Tramadol initiators have also a higher risk of CVD and VTE compared with the diclofenac and Cox-2 inhibitor initiators with HRs ranging from 1.2 to 1.7. Furthermore, tramadol was also associated with a higher risk of HFx compared with all NSAIDs cohorts (HRs ranging from 1.4 to 1.5). No significant difference was found between tramadol and codeine (Table 1).View this table:Table 1 Conclusion: OA patients initiating tramadol have an increased risk of mortality, CVD, VTE, and HFx within 1 year compared with NSAIDs, but no statistically significant difference in the risk was observed between tramadol and codeine.Disclosure of Interests: None declared