Randomised clinical trial: gabapentin vs baclofen in the treatment of suspected refractory gastro‐oesophageal reflux‐induced chronic cough

Abstract

Background: Neuromodulators are considered potential therapeutic options for refractory gastro-oesophageal reflux-induced chronic cough. Aim: To compare the efficacy of gabapentin and baclofen in patients with suspected refractory gastro-oesophageal reflux-induced chronic cough. Methods: Two hundred and thirty-four patients with suspected refractory gastrooesophageal reflux-induced chronic cough, who failed an 8-week course of omeprazole and domperidone, were recruited into the open-labelled study and randomly assigned to receive either gabapentin (maximum daily dose of 900 mg) or baclofen (maximum daily dose of 60 mg) for 8 weeks as add-on therapy to the previous treatment. The primary end point was the successful rate of cough resolution; and the secondary end-points included cough sensitivity to capsaicin and gastro-oesophageal reflux disease questionnaire score and reported side effects. Results:One hundred and eleven patients in the gabapentin group and 106 in the baclofen group completed the study. The overall success rate for cough resolution was comparable (57.3% vs 53.0%, χ 2 = 0.357, P = 0.550) between the two groups.In parallel, cough sensitivity to capsaicin and gastro-oesophageal reflux disease questionnaire score decreased after treatment with either gabapentin or baclofen.However, gabapentin was associated with less frequent somnolence (20.5% vs 35.0%, χ 2 = 6.156, P = 0.013) and dizziness (11.1% vs 23.9%, χ 2 = 6.654, P = 0.010) than baclofen. Conclusions:Gabapentin and baclofen have similar therapeutic efficacy for suspected refractory gastro-oesophageal reflux-induced chronic cough. However, gabapentin may be preferable because of fewer side effects. Trial Register: http:// www.chictr.org/; No.: ChiCTR-ONC-13003066.Ran Dong and Xianghuai Xu contributed equally to this work.

Prediction of Therapeutic Efficacy of Gabapentin by Hull Airway Reflux Questionnaire in Chronic Refractory Cough

“…According to a gradual dose escalation schedule 8 , gabapentin (Hengrui Pharmaceutical Co., Ltd., Jiangsu, China) was given with a starting dose of 100 mg, three times daily, then increased by 100 mg each time every 3 days, until a maximum dose of 900 mg daily (300 mg, three times) was reached or the side effects became intolerant. The treatment was maintained for 8 weeks in patients with a favorable response but discontinued at the end of week 4 for patients unresponsive to gabapentin.…”

“…Recently, gabapentin has well been demonstrated for its antitussive effectiveness in patients with CRC 5 and has become a recommended therapy in the latest ACCP and ERS cough guidelines 2,6 . However, its therapeutic e cacy is suboptimal since approximately 40% of patients fail to gabapentin treatment 7,8 . Therefore, it is imperative to screen patients most likely responsive to gabapentin therapy to improve the success rate and avoid potential adverse effects.…”

Editorial: breaking the cycle of cough in GERD—neuromodulators to the rescue? Authors’ reply

“…The authors’ declarations of personal and financial interests are unchanged from those in the original article …”

“…We thank Drs Naik and Vaezi for their insightful comments regarding our recently published article . The purpose of our study was to compare the efficacy of gabapentin and baclofen as add‐on therapy for the management of suspected refractory gastro‐oesophageal reflux‐induced chronic cough.…”

Editorial: breaking the cycle of cough in GERD—neuromodulators to the rescue?

“…In their open‐label, single centre, randomised controlled trial comparing the efficacy of baclofen versus gabapentin for suspected reflux‐related cough, Dong et al showed similar rates of improvement in subjective cough symptoms (57.3% vs 53.0%) . This study has highlighted an important and challenging topic often faced in clinical practice of patients with persistent cough.…”