Gabapentin may be associated with improved fall-related outcomes in older adults being treated for neuropathic pain

1. In this retrospective cohort study, gabapentin use was associated with a reduced incidence of fall-related healthcare visits in older adults when compared with the use of duloxetine.

2. There was no observable difference in the hazard of having a fall involving a hip fracture or hospitalization, but gabapentin users did have a reduced incidence of fall-related emergency department visits.

Evidence Rating Level: 2 (Good)

Study Rundown: Although gabapentin has been increasingly used for pain relief in older adults, studies suggest that it is also associated with increased fall risk. However, existing studies examining fall risk in gabapentin users have primarily drawn comparisons with medication non-users. This target trial emulation study aimed to directly compare outcomes between gabapentin users with users of duloxetine, another common medication for the treatment of neuropathic pain and fibromyalgia. Compared with duloxetine users, gabapentin users had reduced incidence of a fall-related healthcare visit at one, three, and six months, as well as a much lower hazard of having a fall-related visit. Gabapentin users did not have a statistically significant difference in the hazard of having a fall that involved a hip fracture or being hospitalized for a fall compared with duloxetine users. Furthermore, their hazard of visiting the emergency department for a fall after 1 month of medication use was lower. The generalizability of this study was limited by its observational nature, the risk of confounding by indication, the potential loss to follow-up, a lack of stratification by drug dosages, and the inability to assess other potentially important outcomes like cognition. Nevertheless, this study showed that gabapentin use was associated with improvements in certain fall-related outcomes when compared with duloxetine, a finding which may support clinical decision-making for patients in the future.

Click to read the study in AIM

Relevant Reading: Risk of falls associated with antiepileptic drug use in ambulatory elderly populations: A systematic review

In-Depth [retrospective cohort]: This target trial emulation study aimed to compare fall-related outcomes among gabapentin users and duloxetine users. Eligible participants were those who received at least 1 prescription of gabapentin or duloxetine between January 2014 and December 2021 according to claims data from IBM MarketScan. Inclusion criteria included diagnosis of postherpetic neuralgia, diabetic neuropathy, or fibromyalgia within 365 days before participants entered the cohort; age 65 years or older on entry; and enrollment in a health plan for at least 365 days before and after entry. Exclusion criteria included a prescription of gabapentin or duloxetine within 365 days before cohort entry; a prescription of both gabapentin and duloxetine at entry; and diagnoses of non-skin cancer, seizure, depression, or anxiety. The primary outcome was any inpatient or outpatient visit associated with a fall. Secondary outcomes included a visit associated with a fall involving hip fracture, and emergency department visits or hospitalizations associated with a fall. In all, 52,152 gabapentin users and 4,934 duloxetine users were included in the final cohort. Gabapentin users were more likely to be men (47.3% vs. 36.2%) and to have been diagnosed with diabetic neuropathic pain (80.0% vs. 69.9%) or postherpetic neuralgia (14.8% vs. 5.4%) compared with duloxetine; they were less likely to have been diagnosed with fibromyalgia (11.0% vs. 33.0%). The median initial dose of gabapentin was 200 mg (interquartile range, 100 to 300 mg). Incident gabapentin users had a weighted cumulative incidence of a fall-related visit, per 1000 person-years, at 30, 90, and 180 days of 103.60, 90.44, and 84.44 (95% CI, 78.48 to 90.41), respectively; among duloxetine users, the incidence was 203.43, 177.73, and 158.21 (95% CI, 128.51 to 187.91), respectively. Gabapentin users had a reduced hazard of a healthcare visit related to a fall, with a hazard ratio (HR) of 0.52 (95% CI, 0.43 to 0.64). Gabapentin users and duloxetine users did not have statistically significant differences regarding incidence of falls involving a hip fracture (HR, 0.78 [95% CI, 0.32 to 1.86]) or hospitalization (HR, 0.68 [95% CI, 0.42 to 1.11]). In subgroup analysis, no significant difference in fall hazard was observed between gabapentin users and duloxetine users among participants who had suffered a fall within 365 days before cohort entry (HR, 1.09 [95% CI, 0.63 to 1.90]). Overall, this study demonstrated that gabapentin was not associated with worse fall-related outcomes compared with duloxetine.

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