Gabapentinoids Linked to Increased Asthma Exacerbation Risk: Study
Japan: A study published in Thorax has found that patients with asthma and neuropathic or chronic pain who used gabapentinoids had a higher risk of asthma exacerbations requiring corticosteroid treatment compared with those using tricyclic antidepressants or serotonin-norepinephrine reuptake inhibitors (SNRIs). These findings suggest cautious use of gabapentinoids in patients with asthma.
The study was conducted by Yuya Kimura and colleagues from the Department of Health Services Research at the University of Tokyo Graduate School of Medicine.
Gabapentinoids are widely prescribed for the management of neuropathic and chronic pain. However, concerns regarding respiratory adverse effects have increased following warnings issued by the US Food and Drug Administration. Despite these concerns, evidence directly evaluating the respiratory safety of gabapentinoids in patients with asthma has remained limited.
To address this gap, the investigators conducted a nationwide retrospective cohort study using a Japanese administrative claims database. The study included adults with asthma and a history of neuropathic or chronic pain who newly initiated gabapentinoids or comparator medications, including tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are commonly used first-line therapies for chronic pain in Japan.
The researchers used overlap propensity score weighting to reduce the impact of confounding factors. The primary outcome was asthma exacerbation requiring systemic corticosteroid treatment, while the secondary outcome was asthma-related hospitalization.
The study led to the following findings:
- The cohort comparing gabapentinoids with TCAs included 171,393 gabapentinoid users and 5,916 TCA users.
- Gabapentinoid use was associated with a significantly higher incidence of asthma exacerbations requiring systemic corticosteroid treatment compared with TCA use.
- Patients receiving gabapentinoids also had a higher rate of asthma-related hospitalization than those using TCAs.
- In the cohort comparing gabapentinoids with serotonin-norepinephrine reuptake inhibitors (SNRIs), the analysis included 189,055 gabapentinoid users and 19,800 SNRI users.
- Gabapentinoid treatment was associated with a significantly increased risk of asthma exacerbations requiring corticosteroids compared with SNRI use.
- The increase in asthma-related hospitalization risk in the SNRI comparison did not reach statistical significance.
- Pregabalin was associated with an elevated risk of asthma exacerbations in both comparison cohorts.
- Mirogabalin was also linked to an increased risk of asthma exacerbations in both cohorts.
- Gabapentin did not show a similar association with increased asthma exacerbation risk.
The authors advised cautious use of gabapentinoids in patients with asthma, particularly when treating neuropathic or chronic pain, and emphasized the need to monitor for worsening respiratory symptoms after treatment initiation.
However, they acknowledged several limitations, including the inclusion of only adults aged 40 years or older, the potential for residual confounding due to the observational design, and the inability to assess emergency department visits or long-term outcomes.
The investigators concluded that gabapentinoid use was associated with a higher risk of asthma exacerbations compared with TCAs or SNRIs and called for further studies to clarify the respiratory safety of these medications in broader patient populations.
Reference:
Kimura Y, Jo T, Inoue N, et alGabapentinoids and risk for asthma exacerbations: a nationwide retrospective cohort study. Thorax 2026;81:121-130.
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