Gabapentin Treatment Patterns Among Older Patients After Hospital Discharge for Acute Ischemic Stroke.

Abstract

Importance: Gabapentin is frequently prescribed off-label for pain management following an acute ischemic stroke. However, little is known about optimal gabapentin prescribing practices, such as appropriate treatment duration for specific indications, particularly off-label uses.

Objective: We examined gabapentin treatment patterns among older adults who initiated gabapentin within 30 days of discharge from hospitalization for acute ischemic stroke.

Design: This is an observational, retrospective study of existing administrative claims data of Medicare beneficiaries with acute ischemic stroke (AIS) hospitalizations.

Setting: A national 20% random sample of US Medicare beneficiaries.

Participants: Patients aged 65 years and older who were hospitalized for their first acute ischemic stroke between 2013 and 2021.

Exposures: Gabapentin initiation within 30 days of discharge.

Main outcomes and measures: A novel approach that combines a time-varying proportion of days covered, calculated every two months, with a latent class mixed model to identify and characterize gabapentin treatment patterns during the first 12 months after initiation, accounting for prescription overlap and hospitalizations. An 80% proportion of days covered threshold was applied within each interval to distinguish high versus low medication coverage.

Results: The analytic cohort (N=1,628) had a mean age of 76.4 (IQR 70-82) years and was 60% female and 76.5% non-Hispanic White. The latent class mixed model identified three distinct gabapentin treatment patterns: 692 patients (42.5%) experienced rapid low medication coverage (proportion of days covered <80%) within two months after initiation; 96 patients (5.9%) experienced gradually declining medication coverage over 8 months after initiation; and 840 patients (51.6%) maintained high and stable medication coverage for at least one year.

Conclusions and relevance: In this nationwide sample, half of older adults hospitalized for acute ischemic stroke and who initiated gabapentin within 30 days of discharge had gabapentin coverage for 12 months or longer after initiation.