Tramadol is associated with lower odds of infection, bowel obstruction or ileus, and mortality compared with traditional opioids in patients with inflammatory bowel disease (IBD), according to a study published in Inflammatory Bowel Diseases.
Traditional opioid use among patients with IBD is associated with increased mortality and infections, but whether tramadol is associated with similar complications is unknown. For this reason, researchers compared the odds of infection, bowel obstruction or ileus, IBD-related surgery, and mortality among patients with IBD who were prescribed tramadol with those who were prescribed traditional opioids using data from the Danish health registry. The cohort study included patients aged 18 years and older in Denmark with incident Crohn’s disease (CD) or ulcerative colitis (UC) between January 1, 1995, and January 3, 2021. The cohorts in the study included the initial and persistent use populations. Cohort characteristics for initial users included 37,377 patients, with 18,807 using tramadol for a mean of 3.9 years and 18,570 using traditional opioids for a mean of 4.0 years after IBD diagnosis. The persistent user cohort included 15,237 patients receiving at least 3 consecutive tramadol prescriptions (n=7184) for a mean of 4.3 years or traditional opioids (n=8053) for a mean of 4.6 years after IBD diagnosis.
When compared with traditional opioids, initial users of tramadol had lower rates of infections (2.6% vs 3.1%), bowel obstruction or ileus (0.7% vs 1.1%), and mortality (2.4% vs 5.1%). Patients who received tramadol also had lower odds of infection and mortality but higher odds of IBD-related surgery (1.8% vs 1.2%) compared with traditional opioid users.
Compared with persistent users of traditional opioids, persistent users of tramadol had lower rates of infection (6.1% vs 9.3%), bowel obstruction or ileus (1.5% vs 2.9%), and mortality (6.5% vs 16.0%). However, they had a similar proportion of surgery related to inflammatory bowel disease (3.2% vs 3.1%).
Study limitations include confounding by indication, the homogeneity of the Danish population, and no data regarding IBD activity indices or indications for analgesics.
Researchers concluded, “In summary, initial and persistent use of tramadol were associated with lower odds of infection, bowel obstruction or ileus, and mortality when compared with initial and persistent use of [traditional opioids] in a nationwide cohort of patients with IBD.”
Dalal RS, Lund K, Zegers FD, Friedman S, Allegretti JR, Nørgård BM. Use of tramadol vs traditional opioids and adverse outcomes in patients with inflammatory bowel disease: A danish nationwide cohort study. Inflamm Bowel Dis. Published online July 31, 2023. doi:10.1093/ibd/izad156