Chaitoff Alexander, Desai Rishi J, Choudhry Niteesh K, Jungo Katharina T, Haff Nancy, Lauffenburger Julie C
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, and Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (A.C.).
Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (R.J.D., N.K.C., N.H., J.C.L.).
Ann Intern Med. 2025 Feb;178(2):187-198. doi: 10.7326/ANNALS-24-00636. Epub 2025 Jan 7.
The evidence informing the harms of gabapentin use are at risk of bias from comparing users with nonusers.
To describe the risk for fall-related outcomes in older adults starting treatment with gabapentin versus duloxetine.
New user, active comparator study using a target trial emulation framework.
MarketScan (IBM) commercial claims between January 2014 and December 2021.
Adults aged 65 years or older with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia and without depression, anxiety, seizures, or cancer in the 365 days before cohort entry.
New initiation of treatment with gabapentin or duloxetine (comparator).
The primary outcome was the hazard of experiencing any fall-related visit in the 6 months after initiating gabapentin or duloxetine until discontinuation of treatment. Secondary outcomes were hazard of severe fall-related events defined as a fall associated with hip fracture or emergency department visit or hospitalization associated with a fall. Stabilized inverse probability of treatment weighting was used to adjust for baseline characteristics.
Our analytic cohort included 57 086 older adults with a diagnosis of interest initiating treatment with gabapentin ( = 52 152) or duloxetine ( = 4934). Overall median follow-up duration was 30 days (IQR, 30 to 90 days). Weighted cumulative incidence of a fall-related visit per 1000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users and 203.43, 177.73, and 158.21 for duloxetine users, respectively. At 6-month follow-up, incident gabapentin users had lower hazard of falls (hazard ratio, 0.52 [95% CI, 0.43 to 0.64]), but there was no difference in the hazards of experiencing severe falls. Results were similar across sensitivity and subgroup analyses.
Claims may contain fewer frail adults and undercount falls.
Compared with incident use of duloxetine, incident use of gabapentin was not associated with increased fall-related visits.
None.
通过比较加巴喷丁使用者与非使用者来了解加巴喷丁使用危害的证据存在偏差风险。
描述开始使用加巴喷丁与度洛西汀治疗的老年人发生跌倒相关结局的风险。
采用目标试验模拟框架的新使用者、活性对照研究。
2014年1月至2021年12月期间的MarketScan（IBM）商业索赔数据。
65岁及以上患有糖尿病性神经病变、带状疱疹后神经痛或纤维肌痛且在队列进入前365天内无抑郁、焦虑、癫痫或癌症的成年人。
新开始使用加巴喷丁或度洛西汀（对照）治疗。
主要结局是在开始使用加巴喷丁或度洛西汀直至停药后的6个月内发生任何跌倒相关就诊的风险。次要结局是严重跌倒相关事件的风险，定义为与髋部骨折相关的跌倒或与跌倒相关的急诊科就诊或住院。使用稳定的治疗权重逆概率来调整基线特征。
我们的分析队列包括57086名诊断为感兴趣疾病并开始使用加巴喷丁（n = 52152）或度洛西汀（n = 4934）治疗的老年人。总体中位随访时间为30天（四分位间距，30至90天）。加巴喷丁使用者在30、90和180天时每1000人年跌倒相关就诊的加权累积发病率分别为103.60、90.44和84.44，度洛西汀使用者分别为203.43、177.73和158.21。在6个月随访时，新使用加巴喷丁的使用者跌倒风险较低（风险比，0.52 [95%置信区间，0.43至0.64]），但在发生严重跌倒的风险方面没有差异。敏感性分析和亚组分析的结果相似。
索赔数据中可能包含较少的体弱成年人且跌倒计数不足。
与新使用度洛西汀相比，新使用加巴喷丁与跌倒相关就诊增加无关。
无。
