Clinical question: Is gabapentinoid use associated with severe exacerbation in patients with chronic obstructive pulmonary disease (COPD)?
Background: The U.S. Food and Drug Administration issued a warning in 2019 based on a growing number of case reports describing severe breathing complications in patients using gabapentinoids. However, it had never been studied whether gabapentinoids are associated with respiratory adverse effects.
Study design: A population-based cohort study
Setting: Healthcare database including all Quebec residents
Synopsis: This study examined a cohort of 13,504 patients with COPD and gabapentinoid use and matched them to patients with COPD without use. Across all indications (epilepsy, neuropathic pain, and other chronic pain), gabapentinoid use was associated with an increased risk for severe COPD exacerbation. Adjusted hazard ratios for severe COPD exacerbation in patients on gabapentinoids were 1.58 for the indication of epilepsy, 1.35 for neuropathic pain, and 1.49 for other chronic pain. The overall cohort had an incidence rate of 15.1 in gabapentinoid users compared to 8.3 for non-users, with an HR of 1.39. One possible confounder includes the possibility that more patients prescribed gabapentinoids were active smokers, as smokers are considered to be at higher risk for substance use disorders and so more likely prescribed gabapentinoids than opiates for pain. However, the authors did try to correct for this by matching for other markers of COPD severity including recent exacerbation, number of classes of respiratory medications prescribed, and COPD duration. Of note, race and ethnicity data was not included. Gabapentin and pregabalin did not differ.
Bottom line: In patients with COPD, gabapentinoid use is associated with severe exacerbations of COPD, which supports recent warnings from regulatory agencies.
Citation: Rahman AA, Dell’Aniello S, et al. Gabapentinoids and risk for severe exacerbation in chronic obstructive pulmonary disease: a population-based cohort study. Ann Intern Med. 2024;177(2):144-54.
Dr. Geraghty
Dr. Geraghty is a hospitalist in the division of hospital medicine at NYU Langone Tisch Hospital and an assistant professor of medicine at the NYU Grossman School of Medicine, both in New York.