Small study finds gabapentin effectively treats hyperemesis gravidarum

Gabapentin may be more effective than standard therapy for hyperemesis gravidarum, according to results of a small trial presented at this year’s virtual American College of Obstetrics and Gynecology Annual Clinical and Scientific Meeting.

“This is the first randomized controlled trial showing a therapy to significantly reduce nausea and vomiting and improve oral nutrition in patients with hyperemesis gravidarum,” Thomas Guttuso Jr., MD, a professor in the department of neurology and co-director of the Movement Disorder Center at the University of Buffalo, told Healio Primary Care. “Furthermore, patients receiving gabapentin were significantly more satisfied with their treatment than patients receiving standard-of-care therapy.”

Guttuso and colleagues conducted the randomized, double-blind, parallel-group controlled trial at three centers from October 2014 through May 2019. Women enrolled in the study had hyperemesis gravidarum and did not respond to previous treatments.

Participants were randomly assigned to receive 1,800 to 2,400 mg of oral gabapentin per day or an active comparator — either oral ondansetron or oral metoclopramide — for 7 days. Women agreed to stop taking any antiemetic therapies during the study.

The researchers evaluated changes in participants’ score on the Motherisk pregnancy-unique quantification of nausea and emesis (PUQE) from baseline to days 5 through 7 of treatment.

A total of 31 women were enrolled and randomized. Of those, 21 participants — 12 women from the gabapentin group and 9 women from the active comparator group — provided outcome data and were included in the analyses.

In an intention-to-treat analysis, researchers found that the gabapentin group had greater reductions in Motherisk-PUQE scores and greater increases in oral nutrition from the baseline compared with women in the active controller group.

Compared with the active controller group, Guttuso and colleagues found that women in the gabapentin groups had higher global satisfaction, relief and a greater desire to continue therapy.

The researchers reported that both groups had a similar adverse events and withdrawals.

Guttuso said that as the study was small, “these results need to be replicated in a much larger randomized controlled trial before gabapentin can be recommended to treat [hyperemesis gravidarum] in routine clinical practice.”

He added that “due to the tremendous need for a safe and effective treatment for [hyperemesis gravidarum] and the promising results of this small study, further research on gabapentin for treating [hyperemesis gravidarum] is merited.”