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Gabapentin Beats Pregabalin for Chronic Sciatica

WEDNESDAY, Oct. 17, 2018 -- For patients with chronic sciatica (CS), gabapentin (GBP) is superior to pregabalin (PGB), with fewer and less severe adverse events (AEs), according to a study published online Oct. 15 in JAMA Neurology.

Kelvin Robertson, from The Townsville Hospital in Australia, and colleagues conducted a preplanned interim analysis of a randomized, double-dummy crossover trial of PGB and GBP for management of CS. Twenty patients were randomly assigned to GBP then PGB or vice versa, each taken for eight weeks, with a one-week washout before crossover; two patients were excluded.

The researchers found that GBP was superior to PGB, with fewer and less severe AEs recorded. Significant visual analogue pain intensity scale reduction (GBP: mean, 7.54 to 5.82; PGB: mean, 7.33 to 6.38) and Oswestry Disability Index reduction (mean, 59.22 to 48.54) was seen for both GBP and PGB. In head-to-head comparison, GBP showed superior reduction in the visual analogue pain intensity scale (mean, GBP: 1.72 versus PGB: 0.94), regardless of the sequence order; the Oswestry Disability Index reduction was unchanged. More frequent adverse events were seen for PGB (81 versus 19 percent), especially when it was taken first.

"GBP was superior to PGB in reducing pain intensity and was associated with fewer and less severe AEs," the authors write. "Gabapentin should be commenced before PGB to permit optimal crossover."

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Posted: October 2018