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

ImportanceGabapentin 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. ObjectiveWe examined gabapentin treatment patterns among older adults who initiated gabapentin within 30 days of discharge from hospitalization for acute ischemic stroke. DesignThis is an observational, retrospective study of existing administrative claims data of Medicare beneficiaries with acute ischemic stroke (AIS) hospitalizations. SettingA national 20% random sample of US Medicare beneficiaries. ParticipantsPatients aged 65 years and older who were hospitalized for their first acute ischemic stroke between 2013 and 2021. ExposuresGabapentin initiation within 30 days of discharge. Main Outcomes and MeasuresA 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. ResultsThe 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 RelevanceIn 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. Key PointsO_ST_ABSQuestionC_ST_ABSAre stroke survivors aged 65 and older receiving a gabapentin prescription for longer than 12 months? Findingsafter analyzing a 20% sample of Medicare beneficiaries, 51.6% of older adults hospitalized for an acute ischemic stroke initiated gabapentin within 30 days of discharge and had gabapentin coverage for 12 months or longer after initiation. MeaningMost stroke survivors aged 65 and older continue receiving a gabapentin prescription 12 months after their stroke.