P055 Gabapentinoid use and the risk of fractures in patients with inflammatory arthritis: nested case-control study in the Clinical Practice Research Datalink Aurum

Scott, Ian C; Daud, Noor; Bailey, James; Twohig, Helen; Hider, Samantha; Mallen, Christian D; Jordan, Kelvin P; Muller, Sara

Abstract

Background/Aims Gabapentinoids are increasingly prescribed in inflammatory arthritis (IA), despite no trial evidence for efficacy at managing pain in this population. Observational studies in non-IA populations suggest gabapentinoids are associated with fractures but are limited by methodological heterogeneity and potential residual confounding. Patients with IA generally have an increased risk of fracture so may be particularly vulnerable. We examined the relationship between fractures and gabapentinoids in patients with IA who had all been prescribed a gabapentinoid at some point (to minimise confounding by indication). Methods Our matched case-control study used linked national data from English primary care (Clinical Practice Research Datalink Aurum) and Hospital Episode Statistics. A cohort was constructed of adults with IA, contributing data 01/01/2004-31/03/2021, and ever prescribed oral gabapentinoids. Cases with an incident fracture post-cohort inclusion were ascertained and were 1:5 risk set-matched (on age/gender/gabapentinoid type) with controls. Gabapentinoid prescription exposure was categorised as: (a) current (overlapping with fracture date); (b) recent (ending 1-60 days pre-fracture); (c) remote (ending >60 days pre-fracture). Conditional logistic regression models determined ORs with 95% CIs for fractures with current or recent vs. remote gabapentinoid use, adjusting for confounders. Results 2,485 cases (mean age 63.0 years; 79.4% female) and 12,244 controls (mean age 62.7 years; 79.6% female) were included. Of cases: 1,512 received gabapentin, 910 pregabalin, and 63 both drugs; 65.6% were remote, 5.5% recent, and 28.9% current users. In adjusted models (Table), current gabapentinoid use had a statistically significant association with fractures (OR vs. remote: 1.36 [95% CI 1.22, 1.51]). Similar associations were seen with gabapentin (OR 1.38 [1.19, 1.60]) and pregabalin (OR 1.40 [1.18, 1.66]). Statistically significant associations were seen for all gabapentin/pregabalin doses except very high dose gabapentin. Associations were strongest in those starting gabapentinoids more recently. Conclusion In patients with IA, the risk of fractures is increased in those currently prescribed gabapentinoids, after accounting for measured and time-invariant unmeasured confounding. Whilst other unmeasured confounding remains possible, given the absence of evidence for gabapentinoid efficacy in patients with IA who are particularly vulnerable to fractures, this highlights a need for efforts to deliver safer gabapentinoid prescribing in this population. Disclosure I.C. Scott: Grants/research support; National Institute for Health and Care Research (NIHR) Advanced Research Fellowship [NIHR300826]. N. Daud: None. J. Bailey: None. H. Twohig: Grants/research support; NIHR Clinical Lectureship. S. Hider: Honoraria; SH has received payment for lecture fees from UCB. C.D. Mallen: Grants/research support; Keele University have received funding for CMD’s salary from the MRC, AHRC, Versus Arthritis, NIHR, and BMS. K.P. Jordan: Grants/research support; KPJ is partly funded by the NIHR Applied Research Collaboration West Midlands. S. Muller: Grants/research support; SM is partly funded by the NIHR Applied Research Collaboration West Midlands.

Citation

Scott, I. C., Daud, N., Bailey, J., Twohig, H., Hider, S., Mallen, C. D., Jordan, K. P., & Muller, S. (2025, April). P055 Gabapentinoid use and the risk of fractures in patients with inflammatory arthritis: nested case-control study in the Clinical Practice Research Datalink Aurum. Poster presented at British Society for Rheumatology Annual Conference 2025, Manchester Central Convention Complex, Manchester, England, UK

• Presentation Conference Type: Poster
• Conference Name: British Society for Rheumatology Annual Conference 2025
• Start Date: Apr 28, 2025
• End Date: Apr 30, 2025
• Acceptance Date: Apr 28, 2025
• Online Publication Date: Apr 28, 2025
• Publication Date: Apr 28, 2025
• Deposit Date: Jun 9, 2025
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/keaf142.097
• Public URL: https://keele-repository.worktribe.com/output/1242615
• Publisher URL: https://academic.oup.com/rheumatology/article/64/Supplement_3/keaf142.097/8115245