Park Elizabeth E, Daniel Laura L, Dickson Alyson L, Corriere Meghan, Nepal Puran, Hall Kathi, Plummer W Dale, Dupont William D, Murray Katherine T, Stein C Michael, Ray Wayne A, Chung Cecilia P
Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Department of Medicine, University of Miami and Miami VA Healthcare System, Miami, Florida.
JAMA Netw Open. 2025 Aug 1;8(8):e2524451. doi: 10.1001/jamanetworkopen.2025.24451.
Both pregabalin and gabapentin are common nonopioid medications used to treat chronic pain, which affects up to 30% of patients. Because pregabalin has greater potency than gabapentin in binding to the α2δ subunit of the L-type calcium channel, pregabalin may be associated with an increased risk for heart failure (HF).
To compare incident hospitalizations and emergency department (ED) visits for HF among new users of pregabalin vs gabapentin among Medicare beneficiaries with noncancer chronic pain.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included data collected between January 1, 2015, and December 21, 2018, for Medicare beneficiaries aged 65 to 89 years with chronic noncancer pain and without a history of HF and terminal illnesses. Data were analyzed from March 21 to December 2, 2024.
New use of pregabalin or gabapentin.
The primary outcome was hospital admission or ED visit with a primary discharge diagnosis of HF. Secondary outcomes were incidence of outpatient HF diagnosis and all-cause mortality. Adjusted hazard ratios (AHRs) were calculated using inverse probability of treatment weighting propensity score adjustment accounting for 231 covariates, including demographic, clinical, and health care utilization variables and medication use.
The cohort included 246 237 Medicare beneficiaries, of whom 18 622 (7.6%) were new users of pregabalin and 227 615 (92.4%) were new users of gabapentin; the cohort was predominantly female (66.8%), with a median age of 73 years (IQR, 69-78 years). During 114 113 person-years of follow-up, 1470 patients had a hospital admission or ED visit for HF. The rate of HF was 18.2 (95% CI, 15.3-21.6) per 1000 person-years for pregabalin and 12.5 (95% CI, 11.9-13.2) per 1000 person-years for gabapentin (AHR, 1.48 [95% CI, 1.19-1.77]). When restricted to patients with a history of cardiovascular disease, pregabalin was associated with an elevated HF risk compared with gabapentin (AHR, 1.85 [95% CI, 1.38-2.47]). Increased risk of outpatient HF incidence was also noted among patients receiving pregabalin compared with those receiving gabapentin (AHR, 1.27 [95% CI, 1.02-1.58]). All-cause mortality was not significantly different between groups (AHR, 1.26 [95% CI, 0.95-1.76]).
In this retrospective cohort study of Medicare beneficiaries with chronic noncancer pain, incident HF was increased in new users of pregabalin compared with new users of gabapentin. These findings should be considered, especially in patients with a history of cardiovascular disease.
普瑞巴林和加巴喷丁都是用于治疗慢性疼痛的常见非阿片类药物，慢性疼痛影响着多达30%的患者。由于普瑞巴林在与L型钙通道的α2δ亚基结合方面比加巴喷丁具有更强的效力，普瑞巴林可能与心力衰竭（HF）风险增加有关。
比较患有非癌性慢性疼痛的医疗保险受益人中，普瑞巴林新使用者与加巴喷丁新使用者因心力衰竭而住院和急诊就诊的情况。
设计、设置和参与者：这项回顾性队列研究纳入了2015年1月1日至2018年12月21日期间收集的，年龄在65至89岁之间、患有慢性非癌性疼痛且无心力衰竭和晚期疾病病史的医疗保险受益人的数据。数据于2024年3月21日至12月2日进行分析。
普瑞巴林或加巴喷丁的新使用者。
主要结局是因心力衰竭作为主要出院诊断而住院或急诊就诊。次要结局是门诊心力衰竭诊断的发生率和全因死亡率。使用逆概率治疗加权倾向评分调整方法计算调整后的风险比（AHRs），该方法考虑了231个协变量，包括人口统计学、临床和医疗保健利用变量以及药物使用情况。
该队列包括246237名医疗保险受益人，其中18622名（7.6%）是普瑞巴林新使用者，227615名（92.4%）是加巴喷丁新使用者；该队列主要为女性（66.8%），中位年龄为73岁（四分位间距，69 - 78岁）。在114113人年的随访期间，1470名患者因心力衰竭住院或急诊就诊。普瑞巴林使用者的心力衰竭发生率为每1000人年18.2（95%置信区间，15.3 - 21.6），加巴喷丁使用者为每1000人年12.5（95%置信区间，11.9 - 13.2）（AHR，1.48 [95%置信区间，1.19 - 1.77]）。当仅限于有心血管疾病病史的患者时，与加巴喷丁相比，普瑞巴林与更高的心力衰竭风险相关（AHR，1.85 [95%置信区间，1.38 - 2.47]）。与接受加巴喷丁的患者相比，接受普瑞巴林的患者门诊心力衰竭发生率的风险也增加（AHR，1.27 [95%置信区间，1.02 - 1.58]）。两组之间的全因死亡率无显著差异（AHR，1.26 [95%置信区间，0.95 - 1.76]）。
在这项针对患有慢性非癌性疼痛的医疗保险受益人的回顾性队列研究中，与加巴喷丁新使用者相比，普瑞巴林新使用者发生心力衰竭的情况有所增加。这些发现应予以考虑，尤其是在有心血管疾病病史的患者中。
