Pregabalin Shows Higher Efficacy and Safety vs Gabapentin in Neuropathic Pain

Pregabalin demonstrates superior efficacy and safety compared with gabapentin in treating neuropathic pain, with improved pain control, quality of life, and fewer adverse events, according to study results published in Frontiers in Pain Research.

Researchers conducted a systematic review and meta-analysis to evaluate and compare the efficacy and safety of pregabalin vs gabapentin among patients with neuropathic pain. Data were sourced from 4 databases from March to April 2024.

The analysis included 14 comparative studies (clinical trials and cohort studies), representing 3346 unique adult patients (pregabalin group, n=1714; gabapentin group, n=1632). Nonrandomized studies ranged from acceptable to high in regard to methodological quality, and randomized studies had a moderate risk of bias.

Pain assessment tools included the global Visual Analog Scale (VAS) and SF-12/SF-36/EQ-5D questionnaires to better understand pain intensity, pain duration, opioid use, quality of life, costs, and adverse events.

Pregabalin demonstrated better pain outcomes, with a significantly lower global VAS score (standardized mean difference [SMD], -0.47; 95% CI, -0.74 to -0.19), with significant improvements exhibited at 4 weeks (SMD, -0.37; 95% CI, -0.70 to -0.05), 6 to 8 weeks (SMD, -0.31; 95% CI, -0.06 to -0.02), 12 to 14 weeks (SMD, -0.27; 95% CI, -0.42 to -0.12), and 12 months (SMD, -1.44; 95% CI, -2.82 to -0.07) compared with gabapentin. Additionally, higher quality of life metrics were seen with pregabalin (SMD, 0.39; 95% CI, 0.11-0.68) compared with gabapentin.

Further analysis revealed pregabalin resulted in significantly more days with no/mild pain (MD, 9.00; 95% CI, 8.93-9.07) and significantly fewer days with severe pain (MD, -3.00; 95% CI, -4.96 to -1.04), alongside significantly reduced opioid use (odds ratio [OR], 0.50; 95% CI, 0.33–0.76).

Costs, specialist visits, and overall adverse events did not significantly differ between the 2 drugs, but pregabalin had significantly lower incidences of nausea (OR, 0.36; 95% CI, 0.20-0.63; I²=0%; P =.0004) and vomiting (OR, 0.33; 95% CI, 0.13-0.85; I²=0%; P =.02) compared with gabapentin. Pregabalin also exhibited advantages in quality-adjusted life years (MD, 0.01; 95% CI, 0.00-0.01).

Sensitivity analyses confirmed pregabalin’s superiority in VAS scores and lower adverse events at low doses. The GRADE assessment rated evidence as moderate for VAS and opioid use, low for quality of life changes, and very low for other outcomes, emphasizing pregabalin’s efficacy and safety advantages.

Study limitations include potential bias, limited number of studies with adequate blinding, and the inability to individually assess characteristic symptoms and signs of neuropathic pain.

The researchers concluded, “[T]he findings of this study support that pregabalin provides substantial advantages over gabapentin in the management of neuropathic pain.”

This article originally appeared on Clinical Pain Advisor