Pregabalin vs Gabapentin for Neuropathic Pain to Achieve Therapeutic Dose

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For patients with neuropathic pain, first-line treatment strategies often include the use of pregabalin and gabapentin.
For patients with neuropathic pain, first-line treatment strategies often include the use of pregabalin and gabapentin.
The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor's conference coverage.

LAS VEGAS — Patients with neuropathic pain are more likely to achieve effective therapeutic dose when treated with pregabalin compared with gabapentin, and gabapentin was found to often be prescribed to those patients at suboptimal doses, according to a retrospective study presented at PAINWeek 2017 in Las Vegas, Nevada.1

For patients with neuropathic pain, first-line treatment strategies often include the use of pregabalin and gabapentin, which share the same mechanism of action. Therapeutic ranges for these medications vary by practice.

At this time, there is no conclusive research to suggest optimal dosing, titration rates, or time to therapeutic dose. In this study presented at PAINWeek 2017, a research team led by Mena Raouf, PharmD, at the Stratton Veterans Administration (VA) Medical Center in Albany, New York, sought to "evaluate real world prescribing practices of pregabalin and gabapentin and the corresponding impact on patients" who reach the therapeutic range.

This retrospective, observational analysis examined medical records as well as pharmacy claims from the VA Tennessee Valley Healthcare System. Investigators observed patients for 24 months after initiation of gabapentin or pregabalin therapy. Primary endpoints included the percentage of patients reaching a therapeutic dose of either ≥1800 mg/day gabapentin or ≥150 mg/day pregabalin.

The researchers reviewed 1550 charts, which included patients receiving either gabapentin (n=151) or pregabalin (n=151). Average final doses for gabapentin and pregabalin were 1067.1 ± 680.4 mg and 231 ± 134.8 mg, respectively. Thirty-eight patients (25.2%) in the gabapentin group achieved therapeutic dose compared with 120 patients (79.5%) receiving pregabalin (P <.001). The median time to therapeutic dose for patients treated with pregabalin was 1 day compared with 270 days in the gabapentin group. In 37 patients receiving pregabalin (24.5%), therapies were discontinued because of intolerance compared with 20 patients (13.2%) in the gabapentin group (P <.05).

The investigators comment on the need for provider education on gabapentin therapeutic dose ranges as well as improvement in "development of titration protocols aimed at achieving therapeutic doses."

Read more of Clinical Pain Advisor's coverage of PAINWeek 2017 by visiting the conference page.

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Reference

  1. Raouf M, Crumb M, Baker J, Bramell J, Atkinson T. A two-year retrospective study of neuropathic pain management with gabapentin or pregabalin – Are we optimizing use in clinical practice? Presented at: PAINWeek 2017; September 5-9, 2017; Las Vegas, NV. Poster 69.
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