Association Between the Use of Gabapentinoids and Exacerbations of Chronic Obstructive Pulmonary Disease: A
Ranakishor Pelluri1, Lalasa Sri Tulasi Royyuru1, Suresh Varukolu1
1Department of Pharmacy, KL College of Pharmacy, Koneru Lakshmaiah Education Foundation (Deemed to be University), Vaddeswaram, Guntur, India.
Background:
Evidence on gabapentinoids and its respiratory safety among the patients with chronic obstructive pulmonary disease(COPD) or asthma are remains uncertain.
Objective:
To evaluate the risk of exacerbations with gabapentinoids.
Methods:
A thorough literature search up to January 2026 was done across different databases to find real-world studies examining gabapentinoid exposure and respiratory outcomes. The pooled hazard ratios (HRs), 95% confidence interval (CI) and incidence rate ratios (IRRs) were calculate using random-effects models. Subgroup and sensitivity analysis were also performed for included studies. Quality of studies was evaluated using the Newcastle-Ottawa Scale.
Results:
Four cohort studies (seven reports) included to this analysis. Gabapentinoids use did not associated with exacerbations of COPD or asthma (HR = 1.12, 95% CI: 0.93-1.34; p = 0.23; I2 = 90.7%). Further, analysis was stratified by gabapentinoid class and clinical indications. Subgroup analyses showed increased exacerbation risk with gabapentin (HR = 1.27, 95% CI: 1.02-1.58) and pregabalin (HR=1.37, 95% CI: 1.12-1.67), whereas mirogabalin showed no significant association. Elevated risk was consistent across clinical indications (HR = 1.42, 95% CI: 1.35-1.48). Incidence rate analysis demonstrated higher exacerbation incidence among gabapentinoid users (IRR = 1.41, 95% CI: 1.10-1.81; p=0.006).
Conclusions:
Overall, there was no significant association with gabapentinoids. However, gabapentin and pregabalin were linked to increased risk of exacerbations. Therefore, future long-term studies are required to establish this association with underlying biological mechanisms. [PROSPERO ID: CRD420251248968].
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