National trends in gabapentinoid prescribing in osteoarthritis
PHE ePoster Library. Wilkie R. Apr 9, 2019; 257467
Dr. Ross Wilkie
Dr. Ross Wilkie
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Abstract
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Abstract Background:
Amid a substantial increase in gabapentinoid prescribing in the United Kingdom, there are growing concerns over their increasing unlicensed ('off-label') use and potential for misuse. In osteoarthritis, one of the most common painful conditions in the adult population, there are anecdotal reports of increasing off-label gabapentinoid prescribing for pain control. Using national primary care data, we estimated the trend in the rate of new gabapentinoid prescriptions in patients with osteoarthritis and the proportion attributable to osteoarthritis.
Methods:
: Patients aged 40+ years with a new diagnosis of osteoarthritis recorded between 1995-2015 were identified in the Clinical Practice Research Datalink 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 in this cohort, and stratified rates by patient age, sex, geographical region, and time since osteoarthritis diagnosis. Using diagnostic codes around the date of first gabapentinoid prescription, we estimated the proportion of prescriptions attributable to osteoarthritis versus licensed indications.
Results:
: Of 383,680 newly diagnosed osteoarthritis cases, 35,031 were prescribed at least one gabapentinoid. The annual age-standardised incidence rate of first gabapentinoid prescriptions rose from 1.6 (95% CI: 1.3, 2.0) per 1,000 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 ages, and in Northern Ireland, Scotland and the North of England. Approximately 9-10% of first prescriptions could be attributed to osteoarthritis, a further 11-12% to a comorbid licensed indication.Conclusion: Patients with osteoarthritis have become increasingly likely to receive a gabapentinoid. A significant proportion appears to be off-label use for osteoarthritis pain control despite little trial evidence of effectiveness. The effect of reclassifying gabapentinoids as class C drugs on osteoarthritis care and outcomes warrants investigation.
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