Association between the use of gabapentinoids and exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Purpose Evidence on gabapentinoids and its respiratory safety among the patients with chronic obstructive pulmonary disease (COPD) or asthma are remains uncertain. Hence, the present review was undertaken to evaluate the risk of exacerbations. Methods A thorough literature search up to January 2026 was done across different databases to find real-world studies examining gabapentinoid exposure and respiratory outcomes. The pooled hazard ratios (HRs), 95% confidence interval (CI) and incidence rate ratios (IRRs) were calculate using random-effects models. Subgroup and sensitivity analysis were also performed for included studies. Quality of studies was evaluated using the Newcastle–Ottawa Scale. Findings Four cohort studies (seven reports) included to this analysis. Gabapentinoids use did not associated with exacerbations of COPD or asthma (HR = 1.12, 95% CI: 0.93-1.34; p = 0.23; I ² = 90.7%). Further, analysis were stratified by gabapentinoid class and clinical indications. Subgroup analyses showed increased exacerbation risk with gabapentin (HR = 1.27, 95% CI: 1.02-1.58) and pregabalin (HR=1.37, 95% CI: 1.12-1.67), whereas mirogabalin showed no significant association. Elevated risk was consistent across clinical indications (HR = 1.42, 95% CI: 1.35-1.48). Incidence rate analysis demonstrated higher exacerbation incidence among gabapentinoid users (IRR = 1.41, 95% CI: 1.10-1.81; p=0.006). Conclusions Overall, there was no significant association with gabapentinoids. However, gabapentin and pregabalin were linked to increased risk of exacerbations. Implications Clinicians should consider potential respiratory risks with specific gabapentinoids in COPD or asthma patients; further longitudinal studies are needed to clarify drug-specific effects and mechanisms.