Trends in gabapentinoid prescribing in patients with osteoarthritis: a United Kingdom national cohort study in primary care

Abstract

Objective: To investigate trends in gabapentinoid prescribing in patients with osteoarthritis (OA). Methods: Patients aged 40 years and over with a new OA diagnosis recorded between 1995 and 2015 were identified in the Clinical Practice Research Datalink (CPRD) and followed to first prescription of gabapentin or pregabalin, or other censoring event. We estimated the crude and age-standardised annual incidence rates of gabapentinoid prescribing, stratified by patient age, sex, geographical region, and time since OA diagnosis, and the proportion of prescriptions attributable to OA, or to other conditions representing licensed and unlicensed indications for a gabapentinoid prescription. Results: Of 383,680 newly diagnosed OA cases, 35,031 were prescribed at least one gabapentinoid. Irrespective of indication, the annual age-standardised incidence rate of first gabapentinoid prescriptions rose from 1.6 [95% confidence interval (CI): 1.3, 2.0] per 1000 person-years in 2000, to 27.6 (26.7, 28.4) in 2015, a trend seen across all ages and not explained by length of follow-up. Rates were higher among women, younger patients, and in Northern Ireland, Scotland and the North of England. Approximately 9% of first prescriptions could be attributed to OA, a further 13% to comorbid licensed or unlicensed indications. Conclusion: Gabapentinoid prescribing in patients with OA increased dramatically between 1995 and 2015. In most cases, diagnostic codes for licensed or unlicensed indications were absent. Gabapentinoid prescribing may be attributable to OA in a significant proportion but evidence for their effectiveness in OA is lacking. Further research to investigate clinical decision making around prescribing these expensive and potentially harmful medicines is recommended.

Investigating the prescribing trajectory and geographical drug utilisation patterns of gabapentinoids in primary care in England: An ecological study

“…The result that a higher proportion of females in general practices was negatively associated with prescribing gabapentinoids contradicts previously published studies that female gender was associated with a higher risk of being prescribed gabapentinoids. 11,12,45 This discrepancy might be due to the limitation of applying aggregate-level data.…”

“…Several other studies suggest that the factors influencing the prescribing of gabapentinoids and opioids were similar and gabapentinoids were increasingly co-prescribed with opioids in the UK. 2,11,45,51 According to two Canadian studies, gabapentinoid utilisation was associated with an increased risk of opioid-related death in opioid users. 52,53 Meanwhile, the potential for gabapentinoid addiction has been explored in both laboratory models and clinical studies.…”

“…2 Patients' demographics and comorbidities were also related to gabapentinoids prescribing. [11][12][13] A study of pregabalin users collecting data from another UK primary care database, The Health Improvement Network, found the median age of users was 58 years, and the majority were female (60.1%). 12 Another UK CPRD study, including patients over 40 with osteoarthritis, found that female and younger patients had higher incidence rates of being prescribed gabapentinoids.…”

“…12 Another UK CPRD study, including patients over 40 with osteoarthritis, found that female and younger patients had higher incidence rates of being prescribed gabapentinoids. 11 However, the current literature on gabapentinoid utilisation, regardless of using aggregate-level or individual-patient data, have not considered all the major contributing factors or explored their relationship with gabapentinoid prescribing. Hence, they may have overlooked some issues related to gabapentinoid utilisation and factors associated with potential harm.…”

Antidepressant and anticonvulsant prescription rates in patients with osteoarthritis: a population-based cohort study

“…Although none of these medications are registered for OA pain in the Netherlands, it might be that general practitioners (GPs) do already prescribe these as off-label medications for OA-related pain. A recent retrospective cohort study in the UK found an almost 3-fold increase in first prescriptions of gabapentin and pregabalin in patients with OA between 2005 and 2015 [ 27 ]. Earlier studies in US insurance claims databases found 20–30% of the OA patients used an antidepressant, and around 15% used an anticonvulsant, which was higher than in patients without OA.…”