Table 3.
Study Outcomes of Risk of Pneumonia Including Subgroups
| Study and year | Immuno-suppressive opioids* vs. non-use, aOR (95% CI) | MEDD dose, aOR (95% CI) | Recency of use, aOR (95% CI) | Long and short-acting, vs. non-use, aOR (95% CI) | Overall risk, current use vs. non-use, aOR (95% CI) |
|---|---|---|---|---|---|
| Dublin et al., 2011 |
IS = 1.88 (1.26–2.79) NIS = 1.23 (0.89–1.69) |
< 20 mg = 1.05 (0.71–1.56) 20-49 mg = 2.30 (1.10–4.83) ≥ 50 mg = 1.37 (0.64–2.92) |
5–14 d = 3.24 (1.64–6.39) 15–30 d = 1.28 (0.72–2.29) 31–90 d = 1.24 (0.78–1.99) > 90 d = 1.27 (0.91–1.77) |
Short = 1.27 (0.98–1.64) Long = 3.43 (1.44–8.21) |
aOR = 1.38 (1.08, 1.76) |
| Vozoris et al., 2016 | NR | < 30 mg similar to ≥ 30 mg dosing | NR |
Short = 1.50 (1.26–1.79) Long = 1.86 (1.23–2.81) |
aHR† = 1.08 (0.97–1.21) |
| Velly et al., 2017 |
IS = 1.90 (1.72–2.11) NIS = 1.80 (1.58–2.06) Tramadol = 2.04 (1.65–2.53) Oxycodone = 5.55 (2.17–14.2) Morphine = 4.84 (3.12–7.51) Fentanyl = 2.52 (1.55–4.11) Codeine = 1.65 (1.48–1.85) Hydrocodone = 1.34 (1.11–1.62) |
NR | NR | NR | aOR = 1.83 (1.68–1.99) |
| Wiese et al., 2018 |
IS = 1.74 (1.20–2.53) NIS = 1.55 (1.27–1.88) |
< 50 mg, 1.54 (1.26–1.88) 50–90 mg, 1.71 (1.22–2.39) ≥ 90 mg, 1.75 (1.33–2.29) |
New use = 2.44(1.49–4.00) Recent past use = 1.03(0.87–1.21) |
Short = 1.58 (1.32–1.90) Long = 1.87 (1.24–2.82) |
aOR = 1.62 (1.36–1.92) |
| Edelman et al., 2019 |
IS = 1.42 (1.21–1.67) NIS = 1.24 (1.09–1.40) |
IS: < 20 mg = 1.35 (1.07–1.70) 20–50 mg = 2.07 (1.59–2.71) > 50 mg = 3.18 (2.44–4.14) NIS: < 20 mg = 1.23 (1.03–1.48) 20–50 mg = 1.35 (1.13–1.62) > 50 mg = 2.07 (1.50–2.86) |
NR | NR |
aOR = 1.42 (1.31–1.54) |
| Hamina et al., 2019 |
IS = 1.68 (1.20–2.36) NIS = 2.91 (1.94–4.34 |
< 50 mg = 1.36 (1.13–1.62) ≥ 50 mg 2.86 (1.72–4.72) |
< 60 d = 2.58 (1.87–3.55) 61–180 d = 1.42 (1.00–2.02) 181–365 = 0.91 (0.62–1.33) > 365 = 0.90 (0.65–1.25) |
NR | aHR = 1.34 (1.14–1.57) |
| Kim et al., 2019 | NR | NR | NR | NR |
aHR = 1.14 (0.70–1.84) for continuous use aHR = 0.81 (0.60–1.09) for intermittent use |
| Shah et al., 2019 | NR | NR | NR | NR | NR |
Non-immunosuppressive opioids include hydrocodone, buprenorphine, hydromorphone, oxycodone, oxycodone/naloxone, tramadol
IS immunosuppressive, NIS non-immunosuppressive, MEDD morphine equivalent daily dose, d days, NR not reported, aHR adjusted hazard ratio
*Immunosuppressive opioids include codeine, morphine, fentanyl, diamorphine, dihydrocodeine, and sufentanil
†Vozoris reports risk of hospitalization for pneumonia or COPD exacerbation