In patients with chronic sciatica, gabapentin was associated with a greater reduction in leg pain intensity and fewer side effects compared with pregabalin, according to a study published in JAMA Neurology.
In this prospective, cohort study, patients (N=18) were randomized to receive gabapentin 400–800mg 3 times daily then pregabalin 150–300mg twice daily or vice versa; each treatment regimen was taken for 8 weeks with a 1-week washout period in between. “While gabapentin and pregabalin are both currently used to treat chronic sciatica, a position of equipoise appears to exist regarding which to choose,” explained the study authors. The primary outcome of the study was change in pain intensity, as assessed by the 10-point visual analog scale, from baseline to week 8; secondary outcome measures included disability and adverse event severity and frequency.
Results showed that both treatments were associated with a significant reduction on the visual analog pain intensity scale (gabapentin: mean [SD] 7.54 [1.39] to 5.82 [1.72]; P <.001) and pregabalin (mean [SD] 7.33 [1.30] to 6.38 [1.88]; P=.002) and on the Oswestry Disability Index, used to measure disability (gabapentin (mean [SD], 59.22 [16.88] to 48.54 [15.52]; P <.001) and pregabalin (mean [SD] 59.22 [13.24] to 50.44 [16.58]; P<.001); this effect was not impacted by the order in which the regimens were given.
Regardless of treatment sequence, there was a greater mean visual analog score reduction associated with gabapentin (mean [SD] 1.72 [1.17]) vs pregabalin (mean [SD] 0.94 [1.09]; P =.035), however, no significant difference was observed in Oswestry Disability Index reduction when compared head-to-head.
With regard to safety, adverse events were more frequent with pregabalin compared with gabapentin (81% vs 19%; P =.002), particularly when pregabalin was administered first.
“Our study…represents the first prospective randomized cohort of patients with chronic sciatica to comprehensively assess the head-to-head efficacy of pregabalin and gabapentin, the associated frequency and severity of adverse events, and the impact of pregabalin-gabapentin interchange,” write the authors. They added that “gabapentin should be commenced before pregabalin to permit optimal crossover of medicines.”
For more information visit JAMAnetwork.com.
This article originally appeared on MPR