Gabapentinoids up risk of severe COPD exacerbation

Use of gabapentinoid can potentially elevate the risk for severe exacerbation in patients with chronic obstructive pulmonary disease (COPD), suggests a study.

This time-conditional, propensity score-matched, new-user cohort study used health insurance databases from the Régie de l’assurance maladie du Québec in Canada to identify patients with COPD between 1994 and 2015.

The authors matched patients who initiated gabapentinoid therapy with an indication (ie, epilepsy, neuropathic pain, or other chronic pain) in a 1:1 ratio with nonusers on COPD duration. Severe COPD exacerbation requiring hospitalization was the primary outcome.

Finally, the authors estimated hazard ratios (HRs) associated with use of gabapentinoid in subcohorts according to gabapentinoid indication and in the overall cohort.

A total of 356 gabapentinoid users with epilepsy, 9,411 with neuropathic pain, and 3,737 with other chronic pain were matched to nonusers.

Users of gabapentinoid had a higher risk for severe COPD exacerbation compared with nonusers. This finding was consistent across the indications of epilepsy (HR, 1.58, 95 percent confidence interval [CI], 1.08‒2.30), neuropathic pain (HR, 1.35, 95 percent CI, 1.24‒1.48), other chronic pain (HR, 1.49, 95 percent CI, 1.27‒1.73), and overall (HR, 1.39, 95 percent CI, 1.29‒1.50).

“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,” the authors said.

Notably, residual confounding and lack of smoking information limited this study.