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Duloxetine, Gabapentin, and the Risk for Acute Myocardial Infarction, Stroke, and Out-of-Hospital Death in Medicare Beneficiaries With Non-Cancer Pain.
Corriere, Meghan A; Dickson, Alyson L; Daniel, Laura L; Nepal, Puran; Hall, Kathi; Plummer, W Dale; Dupont, William D; Murray, Katherine T; Stein, C Michael; Ray, Wayne A; Chung, Cecilia P.
Affiliation
  • Corriere MA; Departments of Medicine.
  • Dickson AL; Departments of Medicine.
  • Daniel LL; Departments of Medicine.
  • Nepal P; Department of Medicine, University of Miami, Miami, FL.
  • Hall K; Departments of Medicine.
  • Plummer WD; Department of Medicine, University of Miami, Miami, FL.
  • Dupont WD; Departments of Medicine.
  • Murray KT; Departments of Biostatistics.
  • Stein CM; Departments of Biostatistics.
  • Ray WA; Departments of Medicine.
  • Chung CP; Departments of Medicine.
Clin J Pain ; 39(5): 203-208, 2023 05 01.
Article in En | MEDLINE | ID: mdl-37094085
ABSTRACT

OBJECTIVE:

Duloxetine is a serotonin-norepinephrine reuptake inhibitor prescribed for musculoskeletal and other forms of chronic pain. Its dual pharmacologic properties have the potential to either raise or lower cardiovascular risk adrenergic activity may increase the risk for acute myocardial infarction (AMI) and stroke, but antiplatelet activity may decrease risk. Gabapentin is another nonopioid medication used to treat pain, which is not thought to have adrenergic/antiplatelet effects. With the current emphasis on the use of nonopioid medications to treat patients with chronic pain, assessing cardiovascular risks associated with these medications among high-risk patients is important. MATERIALS AND

METHODS:

We conducted a retrospective cohort study among a 20% sample of Medicare enrollees, aged 65 to 89, with chronic pain who were new users between 2015 and 2018 of either duloxetine (n = 34,009) or gabapentin (n = 233,060). We excluded individuals with cancer or other life-threatening conditions at study drug initiation. The primary outcome was a composite of AMI, stroke, and out-of-hospital mortality. We adjusted for comorbidity differences with time-dependent inverse probability of treatment weighting.

RESULTS:

During 115,668 person-years of follow-up, 2361 patients had the composite primary outcome; the rate among new users of duloxetine was 16.7/1000 person-years compared with new users of gabapentin (21.1/1000 person-years), adjusted hazard ratio = 0.98 (95% CI 0.83, 1.16). Results were similar for the individual components of the composite outcome as well as in analyses stratified by demographic and clinical characteristics.

DISCUSSION:

In summary, cohort Medicare patients with non-cancer pain beginning treatment with duloxetine had rates of AMI, stroke, and out-of-hospital mortality comparable to those who initiated gabapentin.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Stroke / Chronic Pain / Myocardial Infarction Type of study: Etiology_studies / Observational_studies / Risk_factors_studies Limits: Aged / Humans Country/Region as subject: America do norte Language: En Journal: Clin J Pain Journal subject: NEUROLOGIA / PSICOFISIOLOGIA Year: 2023 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Stroke / Chronic Pain / Myocardial Infarction Type of study: Etiology_studies / Observational_studies / Risk_factors_studies Limits: Aged / Humans Country/Region as subject: America do norte Language: En Journal: Clin J Pain Journal subject: NEUROLOGIA / PSICOFISIOLOGIA Year: 2023 Document type: Article