Concurrent Gabapentin and Opioid Use and Risk of Mortality in Medicare Recipients with Non-Cancer Pain.
Concurrent Gabapentin and Opioid Use and Risk of Mortality in Medicare Recipients with Non-Cancer Pain.
复制标题
患有非癌症疼痛的医疗保险接受者同时使用加巴喷丁和阿片类药物以及死亡风险。
DOI：
10.1002/cpt.3019
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发表时间：
2023
影响因子：
6.7
通讯作者：
Chung,CeciliaP
中科院分区：
文献类型：
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作者：
Corriere,MeghanA;Daniel,LauraL;Dickson,AlysonL;Nepal,Puran;Hall,Kathi;Plummer,WDale;Dupont,WilliamD;Murray,KatherineT;Stein,CMichael;Ray,WayneA;Chung,CeciliaP
加巴喷丁是治疗疼痛的处方药，通常被认为是安全的。然而，加巴喷丁可引起呼吸抑制，伴随中枢神经系统抑制剂（如阿片类药物）加重呼吸抑制，这是弱势群体的一个问题。我们比较了20%的医疗保险样本中加巴喷丁或度洛西汀合并或不合并阿片类药物的新使用者的死亡率。我们进行了一项新用户设计的回顾性队列研究，纳入了年龄在65-89岁之间，患有非癌症慢性疼痛且无严重疾病的医疗保险参保者，他们在2015年至2018年期间服用了加巴喷丁（n= 233,060）或度洛西汀（n= 34,009）。每日阿片类药物剂量，以吗啡毫克当量（MMEs）估算，根据疾病控制和预防中心（CDC）的建议分为无、低（0 < MME < 50）和高（≥50 MME）。结果是全因死亡率（主要）和院外死亡率（次要）。我们使用治疗权重的逆概率来调整加巴喷丁和度洛西汀使用者之间的差异。在116,707人年的随访中，1,379名患者死亡。加巴喷丁服用者的全因死亡率为12.16 / 1000人年，而度洛西汀服用者为9.94 / 1000人年。不同时使用阿片类药物(调整风险比（aHR) = 1.03, 95%可信区间（CI）： 0.80-1.31）或每日使用低剂量阿片类药物（aHR = 1.06, 95% CI: 0.63-1.76）的使用者的风险相似。然而，加巴喷丁同时接受每日高剂量阿片类药物治疗的患者与度洛西汀同时接受高剂量阿片类药物治疗的患者相比，全因死亡率增加（aHR = 2.03, 95% CI: 1.19-3.46）。院外死亡率也得出了类似的结果。在这项对医疗保险受益人的回顾性队列研究中，与同时使用高剂量阿片类药物和度洛西汀相比，同时使用高剂量阿片类药物和加巴喷丁与更高的全因死亡风险相关。
Gabapentin is prescribed for pain and is perceived as safe generally. However, gabapentin can cause respiratory depression, exacerbated by concomitant central nervous system depressants (e.g., opioids), a concern for vulnerable populations. We compared mortality rates among new users of either gabapentin or duloxetine with or without concurrent opioids in the 20% Medicare sample. We conducted a new‐user design retrospective cohort study, in Medicare enrollees ages 65–89 years with noncancer chronic pain and no severe illness who filled prescriptions between 2015 and 2018 for gabapentin (n= 233,060) or duloxetine (n= 34,009). Daily opioid doses, estimated in morphine milligram equivalents (MMEs), were classified into none, low (0 < MME < 50), and high (≥ 50 MME), based on Centers for Disease Control and Prevention (CDC) recommendations. The outcomes were all‐cause mortality (primary) and out‐of‐hospital mortality (secondary). We used inverse probability of treatment weighting to adjust for differences between gabapentin and duloxetine users. During 116,707 person‐years of follow‐up, 1,379 patients died. All‐cause mortality rate in gabapentin users was 12.16 per 1,000 person‐years vs. 9.94 per 1,000 in duloxetine users. Risks were similar for users with no concurrent opioids (adjusted hazard ratio (aHR) = 1.03, 95% confidence interval (CI): 0.80–1.31) or low‐dose daily opioids (aHR = 1.06, 95% CI: 0.63–1.76). However, gabapentin users receiving concurrent high‐dose daily opioids had an increased rate of all‐cause mortality compared with duloxetine users on high‐dose opioids (aHR = 2.03, 95% CI: 1.19–3.46). Out‐of‐hospital mortality yielded similar results. In this retrospective cohort study of Medicare beneficiaries, concurrent use of high‐dose opioids and gabapentin was associated with a higher all‐cause mortality risk than that for concurrent use of high‐dose opioids and duloxetine.