Article Recommended by Dr. Sarah Christensen: Gabapentinoids and Risk for Severe Exacerbation in Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study

This cohort study aimed to investigate the association between gabapentinoid use and severe exacerbations in patients with chronic obstructive pulmonary disease (COPD). The study utilized time-conditional propensity score matching in a new-user cohort, analyzing health insurance databases in Canada. The cohort included gabapentinoid users with epilepsy, neuropathic pain, and other chronic pain, matched 1:1 to nonusers. The primary outcome measured was severe COPD exacerbation requiring hospitalization. The results indicated that gabapentinoid use was associated with an increased risk of severe COPD exacerbation across all indications, including epilepsy, neuropathic pain, and other chronic pain. The hazard ratios for severe exacerbation were elevated in gabapentinoid users compared to nonusers. The study concludes that gabapentinoid use in COPD patients is linked to an elevated risk of severe exacerbation, supporting previous warnings and emphasizing the need for caution when prescribing gabapentin and pregabalin to COPD patients.

The findings of this study contribute valuable insights into the potential risks associated with gabapentinoid use in patients with COPD, shedding light on the concerns raised by health agencies. The increased risk of severe exacerbation highlights the importance of considering alternative approaches to pain management, especially in the context of multi-modal pain control. The study suggests that a solid foundation of non-pharmaceutical approaches, such as behavioral therapy and physical therapy, may be crucial in the treatment of chronic pain. Additionally, the study underscores the significance of addressing smoking as a contributing factor, despite limitations related to the lack of smoking information in the analysis. Overall, this research adds complexity to the understanding of the risks and benefits of gabapentinoid use in COPD patients, prompting a reevaluation of prescribing practices in this population.

https://www.acpjournals.org/doi/10.7326/M23-0849?utm_source=cmpnr&utm_campaign=lfa_240116_1&utm_content=1&cmp=1&utm_medium=email