A retrospective, matched cohort study of potential drug-drug interaction prevalence and opioid utilization in a diabetic peripheral neuropathy population initiated on pregabalin or duloxetine

Abstract

BackgroundAnticipating and controlling drug-drug interactions (DDIs) in older patients with painful diabetic peripheral neuropaty (pDPN) presents a significant challenge to providers. The purpose of this study was to examine the impact of newly initiated pregabalin or duloxetine treatment on Medicare Advantage Prescription Drug (MAPD) plan pDPN patients’ encounters with potential drug-drug interactions, the healthcare cost and utilization consequences of those interactions, and opioid utilization.MethodsStudy subjects required a pregabalin or duloxetine pharmacy claim between 07/01/2008-06/30/2012 (index event), ≥1 inpatient or ≥2 outpatient medical claims with pDPN diagnosis between 01/01/2008-12/31/2012, and ≥12 months pre- and ≥6 post-index enrollment. Propensity score matching was used to balance the pregabalin and duloxetine cohorts on pre-index demographics and comorbidities. Potential DDIs were defined by Micromedex 2.0 and identified by prescription claims. Six-month post-index healthcare utilization (HCU) and costs were calculated using pharmacy and medical claims.ResultsNo significant differences in pre-index demographics or comorbidities were found between pregabalin subjects (n = 446) and duloxetine subjects (n = 446). Potential DDI prevalence was significantly greater (p < 0.0001) among duoxetine subjects (56.7%) than among pregabalin subjects (2.9%). There were no significant differences in HCU or costs between pregablin subjects with and without a potential DDI. By contrast, duloxetine subjects with a potential DDI had higher mean all-cause costs ($13,908 vs. $9,830; p = 0.001), more subjects with ≥1 inpatient visits (35.6% vs 25.4%; p = 0.02), and more subjects with ≥1 emergency room visits (32.8% vs. 20.7%; p = 0.005) in comparison to duloxetine subjects without a potential DDI. There was a trend toward a difference between pregabalin and duloxetine subjects in their respective pre-versus-post differences in milligrams (mg) of morphine equivalents/30 days used (60.2 mg and 176.9 mg, respectively; p = 0.058).ConclusionThe significantly higher prevalence of potential DDIs and potential cost impact found in pDPN duloxetine users, relative to pregabalin users, underscore the importance of considering DDIs when selecting a treatment.

Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use

“…In two recently published articles evaluating, among others, the drug interactions of duloxetine and pregabalin in the treatment of fibromyalgia and diabetic neuropathy [41,42], the authors considered a major interaction of pregabalin to be the reduction of the drug's efficacy by naproxen or ketorolac that they found in the Micromedex 2.0 database. This interaction, however, is not reported in the information brochure of the drug [40], nor can it be found as a publication.…”

Integrating data from randomized controlled trials and observational studies to predict the response to pregabalin in patients with painful diabetic peripheral neuropathy

“…Reasons include shortfalls in proper patient and pain assessment, insufficient diagnostic accuracy, and inadequate knowledge about medications and their appropriate clinical use, combined with relatively limited treatment efficacy [ 5 ]. Patient, clinician, and health care system factors interact to affect these outcomes in pain [ 6 – 10 ].…”

Pharmacokinetics, Pharmacodynamics, Safety, and Tolerability of Mirogabalin When Coadministered With Lorazepam, Zolpidem, Tramadol, or Ethanol: Results From Drug‐Drug Interaction Studies in Healthy Subjects

“…Patients with neuropathic pain are commonly treated with a wide range of drugs to improve symptoms and comorbidities, including pain, sleep dysfunction, and anxiety . Studies have shown that DDIs can significantly increase health care utilization and costs . Therefore, it is critical to characterize any potential DDIs that may negatively impact optimal clinical management.…”

“…8,9 Studies have shown that DDIs can significantly increase health care utilization and costs. 34,35 Therefore, it is critical to characterize any potential DDIs that may negatively impact optimal clinical management.…”