Association Between Gabapentin Receipt for Any Indication and Alcohol Use Disorders Identification Test-Consumption Scores Among Clinical Subpopulations With and Without Alcohol Use Disorder

Abstract

Background: Current medications for alcohol use disorder (AUD) have limited efficacy and utilization. Some clinical trials have shown efficacy for gabapentin among treatment-seeking individuals. The impact of gabapentin on alcohol consumption in a more general sample remains unknown.

Methods: We identified patients prescribed gabapentin for ≥180 consecutive days for any clinical indication other than substance use treatment between 2009 and 2015 in the Veterans Aging Cohort Study. We propensity-score matched each gabapentin-exposed patient with up to 5 unexposed patients. Multivariable difference-in-difference (DiD) linear regression models estimated the differential change in Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores during follow-up between exposed and unexposed patients, by baseline level of alcohol consumption and daily gabapentin dose. Analyses were stratified by AUD history. Clinically meaningful changes were a priori considered a DiD ≥1 point.

Results: Among patients with AUD, AUDIT-C scores decreased 0.39 points (95% confidence interval [CI] 0.05, 0.73) more among exposed than unexposed patients (p < 0.03). Potentially clinically meaningful differences were observed among those with AUD and exposed to ≥1,500 mg/d (DiD 0.77, 95% CI 0.15, 1.38, p < 0.02). No statistically significant effects were found among patients with AUD at doses lower than 1,500 mg/d or baseline AUDIT-C ≥4. Among patients without AUD, we found no overall difference in changes in AUDIT-C scores, nor in analyses stratified by baseline level of alcohol consumption.

Conclusions: Patients exposed to doses of gabapentin consistent with those used in clinical trials, particularly those with AUD, experienced a greater decrease in AUDIT-C scores than matched unexposed patients.

Keywords: Alcohol Use Disorder; Electronic Health Records; Gabapentin; Propensity Score.

Figure 1.

Distribution of propensity scores in gabapentin exposed and unexposed patients in the full cohort before matching, by alcohol use disorder (AUD) history

Figure 2.

Difference-in-difference estimates and 95% confidence intervals of self-reported changes in AUDIT-C scores associated with gabapentin exposure among non-treatment seeking patients and their propensity-score matched controls, by AUD history, baseline AUDIT-C, and prescribed dose of gabapentin Notes: ** for p<0.05, * for p<0.10; Difference-in-difference = reported AUDIT-C decrease among gabapentin exposed patients minus reported AUDIT-C decrease among propensity-score matched unexposed patients Abbreviations: AUDIT-C - Alcohol Use Disorders Identification Test – Consumption; AUD – alcohol use disorder; mg - milligrams