Columbus, OH—Gabapentinoids are prescribed primarily for off-label indications with limited evidence to support their benefits, but that has not stopped the steady increase in use of the drug class, according to a new study.

Researchers from OhioHealth in Columbus, the Veterans’ Affairs Ann Arbor, Michigan, Healthcare System, and the University of Michigan used the 2002–2021 Medical Expenditure Panel Survey to determine the proportion of the U.S. adult population who were gabapentinoid users, the ages of those users, medications and diagnoses associated with users, and the likelihood of starting, stopping, or continuing gabapentinoids.

“Gabapentinoid users continued to increase since our last publication from 4.0% in 2015 to 4.7% in 2021,” the researchers noted in The Annals of Family Medicine. “Gabapentinoid use was much more likely among individuals who used other medications used in chronic pain.”

The study team noted that between 2017 and 2021, many chronic pain conditions were associated with gabapentinoid use, adding, “New gabapentinoid users clearly outnumbered gabapentinoid stoppers between 2011–2012 and 2017–2018, but this difference decreased in the most recent cohorts.”

The researchers said they embarked on the study because of the ongoing pressure to limit the prescribing of opioids and benzodiazepines and because of gaps in the literature.

For the study, gabapentinoid users were identified as an individual who reported a fill of any gabapentinoid during a year. “Because gabapentinoids are commonly prescribed for pain and mental health conditions,” the researchers explained, “we identified other related central nervous system–active medication classes including opioids, benzodiazepines (including benzodiazepine receptor agonists; zolpidem and eszopiclone), serotonin and norepinephrine re-uptake inhibitors, tricyclic anti-depressants, and muscle relaxants (e.g., cyclobenzaprine, baclofen). Medical conditions are self-reported in association with a medical event (prescription drug fill, office visit, etc.). Additionally, all participants were asked if they had diabetes mellitus.”

More than 488,348 individuals were included in the study which indicates that the proportion of the population reporting a gabapentinoid medication increased from 1.2% (95% CI, 1.0-1.4) in 2002 to 4.0% (95% CI, 3.6-4.4) in 2015 and 4.7% (95% CI, 4.4-5.1) in 2021 (P <.001 for 2002–2015 comparison and P <.01 for 2015–2021 comparison).

“The probability of gabapentinoid users increased for nearly all ages between 2002–2004 to 2019–2021; between 2019–2021, the probability of gabapentinoid use among those aged 70+ was around 9%,” according to the authors, who added, “Gabapentinoid use increased with each additional central nervous system–active medication class examined. Between 2018–2021, 37.6% (95% CI, 35.6-39.8) of gabapentinoid users were not users of any of the other medication classes. In 2017–2021, the medical condition with the highest proportion of the population who reported gabapentinoids were musculoskeletal pain and diabetes, but these conditions had lower odds ratios of use than some other conditions such as polyneuropathies and fibromyalgia.”

The investigators advised that the growth in use was primarily driven by gabapentin, and no increase in pregabalin users was detected after 2008 or after generic availability in 2019. “Gabapentinoids continue to be commonly used in conjunction with other sedating medications, which is concerning in light of the U.S. Food and Drug Administration’s 2019 warning about co-prescribing of gabapentinoids with other central nervous system depressants,” the researchers wrote. “Gabapentinoids are likely used for an array of conditions, with the majority being off-label uses for chronic pain with minimal evidence supporting use.”

The researchers suggested continuation of the drugs “should be reconsidered at regular intervals.”

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