Gabapentinoid Elevates Risk for COPD Exacerbations

Sep 26, 2023

Gabapentinoid use in patients with COPD increases the risk for severe exacerbation by almost 50%, underscoring the need for coordinated care.

Patients with COPD who use gabapentinoids have an almost 50% increased risk for severe exacerbations compared with non-users. An adjusted hazard ratio (aHR) of 1.47 also revealed an amplified risk for respiratory failure in these patients.

Several health authorities have issued warnings of possible respiratory problems when using gabapentinoids, also in patients with COPD. At the 2023 ERS International Congress, PhD-candidate Alvi Rahman explained that these warnings are mostly based on case reports and data from large studies supporting this evidence are still lacking. To assess the possibility of a link between gabapentinoid use and hospitalization as equivalent for severe exacerbation in patients with COPD, data were used from the Régie de l’assurance maladie, a provincial health insurance program of Quebec. To enter the study patients had to have a COPD diagnosis and had to be at least 55.

Out of 156,803 patients with COPD, 23,061 patients starting on gabapentinoids were matched 1:1 with non-users by propensity score. Mean age within the cohort was 74.6 years, and 56.5% were women. During the included 72,349 person-years (PY) of follow-up, a total of 6,232 severe COPD exacerbations happened with an incident rate of 14.1 per 100 PY versus 7.6 per 100 PY in gabapentinoid-users vs non-users. This corresponded to an aHR of 1.47. With regard to moderate to severe exacerbations and respiratory failure, aHR of 1.15 and aHR of 1.47 also demonstrated higher risks for those taking gabapentinoids. “We also looked at different patient subgroups to assess whether the risk varied according to the subgroups and overall, the risk was consistent,” Rahman explained, with reference to stratifications for age, sex, previous COPD exacerbations, and different groups of prior medications. Sensitivity analyses that were conducted observed results that supported the main findings.

Rahman concluded that this was the first population-based study to demonstrate an association between gabapentinoid use and severe COPD exacerbation. “It supports previous warnings from the health agencies, and it emphasizes close monitoring and a risk-benefit assessment when prescribing gabapentinoids in this population,” Rahman said. He further encouraged good coordination of care between general practitioners and specialists about prescribing these drugs.