Gabapentin Shows Lower Fall Risk Than Duloxetine in Elderly

TOPLINE:

Among 57,086 older adults, new gabapentin users demonstrated lower fall-related healthcare visits than duloxetine users, with a weighted cumulative incidence of 84.44 vs 158.21 per 1000 person-years at 180 days. Incident gabapentin use showed a 48% lower hazard of falls at 6-month follow-up, with no increase in severe fall-related events.

METHODOLOGY:

• Researchers conducted a new user, active comparator cohort study using IBM MarketScan Research Databases from January 2014 to December 2021.
• Analysis included 57,086 adults aged ≥ 65 years with postherpetic neuralgia, diabetic neuropathy, or fibromyalgia, excluding those with depression, anxiety, seizures, or cancer in the prior 365 days.
• The primary outcome measured the hazard of experiencing any fall-related visit in the 6 months after initiating gabapentin or duloxetine until treatment discontinuation.
• Secondary outcomes examined severe fall-related events, including falls with hip fractures or emergency department visits/hospitalizations associated with falls.

TAKEAWAY:

• The analytic cohort included 52,152 gabapentin users and 4934 duloxetine users, with a median follow-up duration of 30 days (interquartile range, 30-90 days).
• Weighted cumulative incidence of fall-related visits per 1000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users vs 203.43, 177.73, and 158.21 for duloxetine users.
• At 6-month follow-up, incident gabapentin users demonstrated lower hazard of falls (hazard ratio, 0.52; 95% CI, 0.43-0.64), with no difference in hazards of severe falls.
• Results remained consistent across sensitivity and subgroup analyses.

IN PRACTICE:

“One bioplausible explanation for our results is that gabapentin is a highly titratable medication and many in our cohort started on low doses. Alternatively, duloxetine is usually titrated only once or twice. Thus, although it may be that gabapentin is simply safer than duloxetine from a falls perspective, it may also be likely that we are measuring specific clinical scenarios, the peri-initiation and titration period, in which gabapentin may be less likely to cause falls than duloxetine,” wrote the authors of the study.

SOURCE:

The study was led by Alexander Chaitoff, MD, MPH, Department of Internal Medicine, University of Michigan School of Medicine in Ann Arbor, and Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School in Boston. It was published online in Annals of Internal Medicine.

LIMITATIONS:

Despite the design aimed at limiting confounding effects, the observational nature of the study introduces potential bias. Claims data may undercount falls for which patients do not seek care, though this limitation likely affects both medication groups equally. The commercial claims database includes only Medicare supplemental insurance beneficiaries, potentially limiting generalizability. Additionally, regional variations in prescribing patterns could not be accounted for in the analysis.

DISCLOSURES:

No funding was provided for this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.