Abstract: FR-PO422
The Utilization of Gabapentin and Pregabalin for the Treatment of CKD-Associated Pruritus and Other Indications in Manitoba
Session Information
- Hemodialysis: Quality of Life, Symptoms, Palliative Care
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Leon Mantilla, Silvia Juliana, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Whitlock, Reid, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Harasemiw, Oksana, University of Manitoba, Winnipeg, Manitoba, Canada
- DiNella, Michelle SJ, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Miciak, Gerald, Otsuka Canada Pharmaceutical Inc, Saint Laurent, Quebec, Canada
- Bohm, Clara, University of Manitoba, Winnipeg, Manitoba, Canada
- Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
- Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
- Collister, David Thomas, University of Manitoba, Winnipeg, Manitoba, Canada
- Rigatto, Claudio, University of Manitoba, Winnipeg, Manitoba, Canada
Background
Chronic kidney disease-associated pruritus (CKD-aP) frequently affects patients on dialysis, is associated with reduced quality of life, and was identified as a research priority by patients. Until recently there were no approved treatments for CKD-aP, which was often treated with off-label therapies. Systematic reviews published in 2017-2020 identified GABA (gabapentin, pregabalin) analogues as having evidence for efficacy. This real-world study describes the prescription patterns for GABA over time and their frequency of use for CKD-aP.
Methods
Retrospective cohort study using administrative health data from Manitoba, Canada (>1.2 million residents). We included all adults (≥ 18 years) who received an incident prescription for a GABA between January 1st, 2012, and March 31st, 2022. We calculated the yearly prescription rate per new user for each GABA in total and for each of the following indications: neuropathy, seizure, fibromyalgia, restless legs syndrome (RLS), and chronic pain. Finally, we estimated the total and annual percentage of GABA prescribed for CKD-aP in the chronic dialysis population (defined as dialysis for 90 consecutive days with no gaps >15 days between sessions).
Results
In the study period, there were 125,881 GABA analogue users (adults aged 18 and over). Gabapentin was more commonly prescribed (85%) than pregabalin (15%). The number of new GABA prescriptions increased from 11,301 in 2012 to 12,031 in 2021. Only 0.7% of these were prescribed to treat CKD-aP.
There were 4,028 chronic dialysis patients included. Indications for GABA prescriptions in this group were fibromyalgia (24%), seizures (12%), neuropathic pain (9%), RLS (10%) and CKD-aP (19%). Patients receiving GABA for CKD-aP were mostly men (57%) and were older (mean age 60 vs 56 years) than those in the general population. There was a decrease in the proportion of dialysis patients receiving GABA for CKD-aP from 2017 to 2020 (4% to 2.6%) with an increase in 2021 (4%).
Conclusion
GABA are rarely used for CKD-aP (0.7% of all GABA use), despite evidence of efficacy. We speculate that safety concerns may limit GABA use. Further studies of the risks:benefit of GABA analogues in CKD-aP are needed.
Funding
- Commercial Support – Otsuka Canada Pharmaceutical Inc.