Daily Dose: Gabapentinoids & Risk of Severe COPD Exacerbations

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in Annals of Internal Medicine that assessed whether gabapentinoid use is associated with severe exacerbation in patients with chronic obstructive pulmonary disease (COPD).

The study

Researchers tapped 3 digital health insurance databases from the Régie de l’assurance maladie du Québec in Canada, including data for 13 504 individuals aged 55 years and older with a diagnosis of COPD between 1994 to 2015. Within this cohort, they matched individuals who initiated gabapentinoid therapy for epilepsy (n = 356), neuropathic pain (n = 9411), or other chronic pain (n = 3737) 1:1 with a group not treated with gabapentinoids for duration of COPD, indication for gabapentinoids, age, sex, calendar year, and time-conditional propensity score.

The primary outcome of interest was severe COPD exacerbation requiring hospitalization.

The findings

The investigators reported that compared with individuals with COPD and 1 of the 3 indications who were not taking gabapentinoids, the increased risk for severe COPD exacerbation among those who were exposed was:

• Epilepsy: Hazard ratio (HR) 1.58 (95% CI 1.08-2.30)

• Neuropathic pain: HR 1.35 (95% CI 1.24-1.48)

• Other chronic pain: HR 1.49 (95% CI 1.27-1.73)

Authors' comment

"In patients with COPD, gabapentinoid use was associated with increased risk for severe exacerbation. This study supports the warnings from regulatory agencies and highlights the importance of considering this potential risk when prescribing gabapentin and pregabalin to patients with COPD."

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