Pregabalin use for noncancer pain linked to increased risk of HF

In the treatment of chronic noncancer pain, the use of pregabalin appears to be associated with a higher incidence of heart failure (HF) when compared with gabapentin, according to a retrospective cohort study.

Researchers used data from the nationwide administrative claims Medicare database and identified older adults (65–89 years of age) with chronic noncancer pain without a history of HF and terminal illness. Of these, 18,622 (7.6 percent) were new users of pregabalin and 227,615 (92.4 percent) were new users of gabapentin. The median age overall was 73 years, and 66.8 percent were female.

Hospital admission or ED visit with a primary discharge diagnosis of HF was the primary outcome. Secondary outcomes included outpatient HF diagnosis and all-cause mortality.

Over 114,113 person-years of follow-up, a hospital admission of ED visit for HF occurred in 1,470 patients overall. The incidence rate of HF was higher among pregabalin users than gabapentin user, at 18.2 (95 percent confidence interval [CI], 15.3–21.6) vs 12.5 (95 percent CI, 11.9–13.2) per 1,000 person-years (adjusted hazard ratio [aHR], 1.48, 95 percent CI, 1.19–1.77).

In an analysis restricted to patients with a history of cardiovascular disease, pregabalin remained associated with a heightened risk of HF compared with gabapentin (aHR, 1.85, 95 percent CI, 1.38–2.47).

Pregabalin users were also at increased risk of outpatient HF compared with gabapentin users (aHR, 1.27, 95 percent CI, 1.02–1.58). No between-group difference was seen in all-cause mortality (aHR, 1.26, 95 percent CI, 0.95–1.76).