Gabapentinoid medication elevates risk for COPD exacerbations 

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

Several health authorities have issued warnings of possible respiratory problems when using gabapentinoids, also in patients with chronic obstructive lung disease (COPD) [1]. PhD candidate Alvi Rahman (McGill University, Canada) 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 hospitalisation as equivalent for severe exacerbation in patients with COPD, data was 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 years of age.

Out of 156,803 COPD patients, 23,061 individuals 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 14.1/100 PY versus 7.6/100 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 on gabapentinoids. “We also looked at different patient subgroups to assess whether the risk varied according to the subgroups and overall, the risk was consistent,” Mr 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.

In his conclusion, Mr Rahman underlined 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 emphasises close monitoring and a risk-benefit assessment when prescribing gabapentinoids in this population”, Mr. Rahman indicated. He further encouraged good coordination of care between general practitioners and specialists with regard to prescribing these drugs.

1. Rahman A. Gabapentinoids and the risk of severe exacerbations in patients with chronic obstructive pulmonary disease. Presentation 884, ERS International Congress 2023, 9-13 September, Milan, Italy.

 

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Posted on 13 September, 202313 September, 2023