- Design
- Single-centre, randomised, double-blind, placebo-controlled trial
- Population
- 68 patients with IPF and chronic cough, China
- Primary outcome
- ≥50% reduction in cough symptom score at 12 weeks
- Effect
- 73.5% vs 26.5%, difference 47.1 points (95% CI 26.1–68.0)
This single-centre, double-blind trial in China randomised 68 patients with idiopathic pulmonary fibrosis and chronic cough (visual analogue score 40 mm or more) to gabapentin titrated up to 900 mg a day, or placebo, for 12 weeks. The primary outcome was at least a 50% reduction in cough symptom score.
Cough relief occurred in 73.5% on gabapentin and 26.5% on placebo, an absolute difference of 47 percentage points. Adverse events were 32.4% against 8.8%, mostly drowsiness, fatigue and dizziness.
Cough in IPF is distressing and hard to treat, and antifibrotics do little for it. Gabapentin is cheap and widely available in India, which makes this trial practically relevant. The effect is large, but the trial is small and single-centre, and older patients with IPF are vulnerable to sedation and falls. A careful trial of gabapentin in an individual patient is reasonable while larger trials are awaited.
- Exclude reflux, postnasal drip and ACE inhibitors as contributors first
- Consider a trial of gabapentin for troublesome IPF cough, titrating slowly
- Adjust the dose for renal function
- Warn about drowsiness and dizziness, and review falls risk in older patients
- Stop if there is no benefit after a few weeks
Why it matters
It offers an inexpensive option for a symptom that antifibrotic treatment does not address.
Don't overread it
This was a small single-centre trial; the size of the benefit needs confirmation in larger studies.
The statistics, in plain English
An absolute difference of 47.1 percentage points (95% CI 26.1–68.0) is large, but with only 68 patients the true effect could be considerably smaller. Small single-centre trials often overestimate benefit.
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