Gabapentinoid Use among Medicare Beneficiaries during the Post-Stroke Recovery Period

Background Most studies of gabapentinoid prescribing trends have focused on younger, commercially insured populations. Patterns among vulnerable groups, including older stroke survivors, remain poorly characterized. We described patterns of gabapentinoid initiation among Medicare beneficiaries following acute ischemic stroke (AIS).

We analyzed claims data from a 20% sample of U.S. Medicare beneficiaries aged ≥ 65 years hospitalized for AIS between 2009 and 2022. We included individuals enrolled in traditional Medicare for ≥ 12 months before hospitalization, without prior stroke during this interval, and discharged home or to an inpatient destination for ≤30 days. After excluding those with gabapentinoid use before stroke, we analyzed outpatient gabapentin prescriptions six months after stroke discharge by demographic and clinical characteristics. We calculated the percentage of gabapentinoid initiators by year and U.S. census division, standardized by age, discharge destination, and modified Rankin Score (mRS).

Among 153,728 Medicare stroke survivors who had not previously been prescribed a gabapentinoid in the 6 months before hospitalization, 4.9% received new prescriptions within 6 months after discharge. The median age was 78 years (Quartile Range: 72 - 84), 55% were female, and 81% were Non-Hispanic White. The crude percentage of gabapentinoid initiators increased from 3.6% in 2009 to 5.8% in 2022. The standardized percentages were 3.8% in 2009 and 5.9% in 2022. We reported a 2.1 percentage point difference in gabapentinoid initiation between U.S. census divisions, with the lowest percentage in the New England Division (3.9%) and the highest in the West South Central Division (6.0%). After standardization, the percentage point difference was 1.9% between the highest and lowest U.S. division.

The percentage of U.S. Medicare stroke survivors initiating gabapentinoid increased from 2009 to 2022. We also identified geographic variation, with the highest initiation percentage in the West South Central and the lowest in the New England U.S. Division. Twitter: @MGHValue Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was supported by NIH R01AG073410-01. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Mass General Brigham Institutional Review Board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data supporting this study's findings were collected by the U.S. Centers for Medicare & Medicaid Services (CMS) and were made available by CMS with no direct identifiers. We cannot share the data, which were used under license from CMS for this study.