Initiation of Pregabalin vs Gabapentin and Development of Heart Failure

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Overview

Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Pregabalin Linked to Higher Heart Failure Risk in Seniors Compared to Gabapentin

This retrospective cohort study of Medicare beneficiaries found that new users of pregabalin had an increased risk of heart failure compared to new users of gabapentin. The risk was particularly elevated in those with a history of cardiovascular disease. The study used a large dataset and controlled for over 200 potential confounding factors.

Possible Conflicts of Interest

Dr. Corriere reported receiving personal fees from Vertex Pharmaceuticals, and Dr. Chung reported receiving grants from the University of Miami and the NIH, all outside of the submitted work.

Identified Weaknesses

Limited generalizability

The study population was predominantly female and White, limiting the generalizability of findings to other demographics. Also, the focus on Medicare beneficiaries aged 65-89 years restricts application to younger populations.

Potential unmeasured confounders

Although the study controlled for many variables, unmeasured factors like body mass index, smoking, diet, and socioeconomic status could still confound the relationship between medication use and heart failure risk.

Exposure misclassification

Patient non-adherence to medication could lead to inaccurate estimation of true exposure, potentially biasing the results.

Rating Explanation

This study used a robust methodology including a large sample size, extensive covariate adjustment, and target trial emulation to minimize bias, strengthening the evidence for an association between pregabalin and heart failure risk in older adults. However, limitations regarding generalizability and potential unmeasured confounding warrant a slightly lower rating than 5.

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