Clinical question: Does gabapentinoid use increase the risk of severe exacerbation in patients with chronic obstructive pulmonary disease (COPD)?
Background: Gabapentinoids are indicated for the treatment of epilepsy and neuropathic pain, with increasing off-label use as a perceived safer alternative to opioids. Concerns about respiratory depression as a serious adverse effect are particularly relevant for patients with COPD.
Study design: Time-conditional, propensity-score-matched, new user, cohort study
Setting: Population-based health administrative data in Quebec, Canada
Synopsis: This study examined 13,504 patients aged at least 55 years with COPD who initiated gabapentin or pregabalin for epilepsy, neuropathic pain, or other chronic pain, matched 1:1 with nonusers. Gabapentinoid use was associated with an increased risk of severe COPD exacerbations (hazard ratio, 1.39; 95% CI, 1.29-1.50) across all indications. In patients with neuropathic and other chronic pain, the elevated risk persisted regardless of opioid or benzodiazepine use at entry. Limitations include potential residual confounders, particularly from unmeasured smoking status. These findings are consistent with regulatory warnings and case reports of respiratory risks associated with gabapentinoid use in patients with COPD.
Bottom line: Findings from this large population-based cohort study suggest that gabapentinoids should be prescribed with caution in patients with COPD, given the increased risk of severe exacerbations.
Citation: Rahman AA, et al. Gabapentinoids and risk for severe exacerbation in chronic obstructive pulmonary disease: a population-based cohort study. Ann Intern Med. 2024;177(2):144-154. doi: 10.7326/M23-0849.
Dr. Bhatt is an academic hospitalist in the section of hospital medicine at UPMC Presbyterian Hospital, and an assistant professor of medicine at the University of Pittsburgh School of Medicine, both in Pittsburgh