Routine Care Gefapixant versus Gabapentin in Adult Refractory Chronic Cough Management

Background: Somatic points for cough (SPC) may identify a cough hypersensitivity endotype. We compared routine-care outcomes of Gefapixant (P2X3 antagonist) and Gabapentin in adult refractory/unexplained chronic cough. Methods: Single-centre observational study: historical Gabapentin cohort (n=15) and recent Gefapixant cohort (n=10). Baseline characteristics (age, body mass index (BMI), cough duration, cough disturbance score (CDS) and SPC prevalence) were compared (unpaired t-test/Fisher’s exact). CDS and SPC status were re-assessed after 3–4 months; adverse events and discontinuations were recorded. Results: Twenty-five patients (23 female) were included (Gefapixant: 10/10 female; Gabapentin: 13/15 female). Mean age was 67.3±10.8 vs 59.4±10.2 years (p>0.05), BMI 25.4 vs 26.5, and cough duration 8.4±6.9 vs 8.3±5.2 years (all p>0.05). Baseline CDS was similar (6.43±1.62 Gefapixant vs 7.09±1.37 Gabapentin; p>0.05), as was SPC prevalence (p>0.05). At 3 months, CDS decreased to 2.57±1.27 and 3.50±2.20, respectively (change −3.86±1.95 vs −2.21±2.82; between-group p>0.05). Mean Gabapentin dose was 1106±438 mg/day. Adverse events occurred in 12/15 Gabapentin patients and led to discontinuation in 9/15, whereas all Gefapixant patients reported taste-related adverse events but none discontinued (0/10 vs 9/15; Fisher p