(ASPOT21) Global trends in outpatient gabapentinoid utilization: A cross‐sectional analysis of 67 countries

Background: Gabapentinoids, including gabapentin, pregabalin, gabapentin enacarbil, and mirogabalin, are commonly prescribed for pain management as part of multimodal treatment or as an opioid alternative. However, there are concerns regarding the potential for misuse of gabapentinoids.

Objectives: We aimed to compare trends in outpatient gabapentinoid utilization globally and identify differences in countries with developed economies compared to developing economies.

Methods: In this time-series analysis, we examined outpatient gabapentinoid utilization using the IQVIA MIDAS database across 72 countries from January 2012 through September 2023. Standardized units per 1000 population and annual utilization increases were assessed overall and stratified by the United Nations economic development category. Autoregressive Integrated Moving Average (ARIMA) models were used to analyze trends over the study period and forecast trends for the following three years.

Results: At baseline, there were 1513.2 units per 1000 population of gabapentinoids purchased globally, increasing by 114.5% from 2012 to 2022. Outpatient gabapentinoid utilization showed continuously significant increases for both developed and developing economies. The utilization was over 10 times higher in developed economies (from 6819.0 to 14319.4 units per 1000 population) compared to developing economies (from 308.2 to 865.8 units per 1000 population). Between 2012 and 2022, gabapentinoid utilization increased by 110.0% in developed economies and 214.8% in developing economies. In developed economies, the ARIMA model was (1,1,0)×(0,1,0)4, which captured both short-term trends and seasonal patterns by accounting for previous sales, changes from quarter to quarter, and changes from the same quarter in the previous year for effective prediction. In developing economies, the model was (2,0,0)×(0,1,0)4, which captured longer-term trends when considering sales from the two previous quarters and changes from the same quarter in the previous year.

Conclusions: In both developing and developed economies, there were dramatic increases in gabapentinoid utilization over the study period. Gabapentinoid utilization was consistently higher in developed economies compared to developing economies. Without intervention, outpatient gabapentinoid utilization is predicted to continue rising in both developed and developing economies. It is imperative to closely monitor these trajectories to ensure the safe use of gabapentinoids while balancing appropriate pain management.