Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Dec;89(12):1320-1323.
doi: 10.1136/jnnp-2017-317368. Epub 2018 Apr 16.

Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations

Michael O Kinney  1 , James Morrow  1 , Chris C Patterson  2 , Ellen Campbell  1 , Aline Russell  3 , Henry W Smithson  4 , Linda Parsons  5 , Patrick J Morrison  6 , Rebecca Bromley  7   8 , Brenda Liggan  9 , Norman Delanty  9 , Beth Irwin  1 , Stephen J Hunt  1 , John J Craig  1
Affiliations
Observational Study

Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations

Michael O Kinney et al. J Neurol Neurosurg Psychiatry. 2018 Dec.

Abstract

Objectives: After 20 years of data collection, pregnancy registers have informed prescribing practice. Various populations show trends for a reduction in valproate prescribing, which is associated with an increased risk of anatomical teratogenesis and neurodevelopmental effects in those exposed in utero. Our aim was to determine if any shifts in prescribing trends have occurred in the UK and Ireland Epilepsy and Pregnancy Register cohort and to assess if there had been any change in the overall major congenital malformation (MCM) rate over time.

Methods: The UK and Ireland Epilepsy and Pregnancy Register, a prospective, observational, registration and follow-up study established in 1996, was used to determine the changes in antiepileptic drugs (AEDs) utilised during pregnancy and the MCM rate between 1996 and 2016. Linear regression analysis was used to assess changes in AED utilisation, and Poisson regression was used for the analysis of trends in the MCM rates.

Results: Outcome data for 9247 pregnancies showed a stable percentage of monotherapy to polytherapy prescribing habits over time. After Bonferroni correction, statistically significant (p<0.003) changes were found in monotherapy prescribing with increases in lamotrigine and levetiracetam and decreases in valproate and carbamazepine use. Between 1996 and 2016, the total MCM rate showed a 2.1% reduction per year (incidence risk ratio 0.979 (95% CIs 0.956 to 1.002) but Poisson regression analysis showed that this was not statistically significant p=0.08).

Conclusion: Significant changes are seen in the prescribing habits in this cohort over 20 years, but a statistically significant change in the MCM rate was not detected. This work should be replicated on a larger scale to determine if significant changes are occurring in the MCM rate, which would allow a robust economic estimate of the benefits of improvements in prescribing practice and the personal effect of such changes.

Keywords: epilepsy; neuroepidemiology; obstetrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: MOK has received salary support to conduct a sabbatical out of programme study from UCB paid in its entirety through the Belfast Health and Social Care Trust. JM has received unrestricted educational grants from Eisai, Glaxo Smith Kline, Novartis, Sanofi-Aventis, Pfizer and UCB for the running of the UK Epilepsy and Pregnancy Register. CCP, EC and PJM report no disclosures. AR has received a grant from UCB for funding of a research nurse (2006–2009) and received small contributions from UCB, Glaxo Smith Kline, Eisai, Forth Medical, Cyberonics and Optima Medical to cover the costs of the UK Epilepsy Surgery Meeting in Glasgow in 2011. HWS has been invited to attend advisory board meetings for NAPP and Sanofi-Aventis. LP has received honoraria for presentations from UCB. BI has received sponsorship to attend meetings and honoraria for presentations from Eisai, UCB and Sanofi-Aventis. RB has received lecture fees from Sanofi Aventis (two occasions), received on one occasion conference travel support from UCB Pharma and a single consultancy fee. She has previously provided expert testimony pertaining to fetal anticonvulsant syndrome. BL has received honoraria for attending a UCB pharma Irish Nurse Advisory Board meeting. ND has received unrestricted educational support from UCB Pharma, Eisai, GSK, Janssen-Cilag and Pfizer for running of the Irish Epilepsy Pregnancy register. SJH has received sponsorship to attend meetings from Eisai, UCB and Glaxo Smith Kline. He has also received honoraria for presentations from Pfizer and UCB. JJC has received grants to undertake research and honoraria for giving lectures from UCB-Pharma, Sanofi-Synthelabo, Glaxo Smith Kline, Janssen-Cilag, Pfizer and Eisai.

Publication types

Substances

LinkOut - more resources