[Bedridden elderly and dementia]

Association between gabapentinoids and oedema treated with loop-diuretics: a pooled sequence symmetry analysis from the United States and Denmark

AIMS

To assess the gabapentinoid-oedema-loop diuretic prescribing cascade in adults using large administrative health care databases from the US and Denmark.

METHODS

This study used a sequence symmetry analysis to assess loop diuretic initiation before and after the initiation of gabapentinoids among patients aged 20 years or older without heart failure or chronic kidney disease. Data from MarketScan Commercial and Medicare Supplemental Claims databases (2005 to 2019) and Danish National Prescription Register (2005 to 2018) were analyzed. Use of loop diuretics associated with initiation of selective norepinephrine reuptake inhibitors (SNRI) was used as a negative control. We assessed the pooled temporality of loop diuretic initiation relative to gabapentinoid or SNRI initiation across the two countries. Secular trend-adjusted sequence ratios (aSRs) with 95% Cis were calculated using data from 90 days before and after initiation of gabapentinoids. Pooled ratio of aSRs were calculated by comparing gabapentinoids to SNRIs.

RESULTS

Among the 1,511,493 gabapentinoid initiators (Denmark [n=338,941]; United States [n=1,172,552]), 20,139 patients had a new loop diuretic prescription 90 days before or after gabapentinoid initiation, resulting in a pooled aSR of 1.33 (95% CI 1.06-1.67). The pooled aSR for the negative control (i.e., SNRI) was 0.84 (95% CI 0.75-0.94), which resulted in a pooled ratio of aSRs of 1.58 (95% CI 1.23-2.04). Pooled estimated incidence of the gabapentinoid-loop diuretic prescribing cascade was 8.14 (95% CI, 1.92-34.49) events per 1000 patient years.

CONCLUSION

We identified evidence of the gabapentinoid-oedema-loop diuretic prescribing cascade in two countries.