Gabapentin tied to fewer falls in older adults as opposed to duloxetine

The incident use of gabapentin, compared with duloxetine, does not seem to increase fall-related visits among older adults, according to a study.

A team of investigators conducted this new user, active comparator study using a target trial emulation framework using MarketScan commercial claims between January 2014 and December 2021. They identified adults aged ≥65 years with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia and without depression, anxiety, seizures, or cancer in the year prior to cohort entry.

The risk of experiencing any fall-related visit in the 6 months after treatment initiation was the primary outcome. Secondary outcomes included the risk of severe fall-related events, defined as a fall associated with hip fracture or emergency department visit or hospitalization due to a fall. The investigators used stabilized inverse probability of treatment weighting to adjust for baseline characteristics.

A total of 57,086 participants initiated treatment with gabapentin (n=52,152) or duloxetine (n=4,934), with a median follow-up duration of 30 days.

The weighted cumulative incidence of a fall-related visit per 1,000 person-years for gabapentin users was 103.60 at 30 days, 90.44 at 90 days, and 84.44 at 180 days. The respective values for user of duloxetine were 203.43, 117.73, and 158.21.

At 6-month follow-up, incident gabapentin users demonstrated a reduced risk of falls (hazard ratio, 0.52, 95 percent confidence interval, 0.43–0.64). However, no significant difference was noted in the risk of experiencing severe falls. These findings were consistent across sensitivity and subgroup analyses.

One limitation of this study is the possibility that claims contain fewer frail adults and undercount falls.