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. 2023 Dec;64(12):3196-3204.
doi: 10.1111/epi.17802. Epub 2023 Oct 27.

Patterns of antiseizure medication utilization in the Human Epilepsy Project

Jonah Fox  1 , Sarah Barnard  2 , Shruti H Agashe  3 , Manisha G Holmes  4 , Barry Gidal  5 , Pavel Klein  6 , Bassel W Abou-Khalil  1 , Jacqueline French  7 ; Human Epilepsy Project Investigators
Affiliations

Patterns of antiseizure medication utilization in the Human Epilepsy Project

Jonah Fox et al. Epilepsia. 2023 Dec.

Abstract

Objective: This study was undertaken to ascertain the natural history and patterns of antiseizure medication (ASM) use in newly diagnosed focal epilepsy patients who were initially started on monotherapy.

Methods: The data were derived from the Human Epilepsy Project. Differences between the durations of the most commonly first prescribed ASM monotherapies were assessed using a Cox proportional hazards model. Subjects were classified into three groups: monotherapy, sequential monotherapy, and polytherapy.

Results: A total of 443 patients were included in the analysis, with a median age of 32 years (interquartile range [IQR] = 20-44) and median follow-up time of 3.2 years (IQR = 2.4-4.2); 161 (36.3%) patients remained on monotherapy with their initially prescribed ASM at the time of their last follow-up. The mean (SEM) and median (IQR) duration that patients stayed on monotherapy with their initial ASM was 2.1 (2.0-2.2) and 1.9 (.3-3.5) years, respectively. The most commonly prescribed initial ASM was levetiracetam (254, 57.3%), followed by lamotrigine (77, 17.4%), oxcarbazepine (38, 8.6%), and carbamazepine (24, 5.4%). Among those who did not remain on the initial monotherapy, 167 (59.2%) transitioned to another ASM as monotherapy (sequential monotherapy) and 115 (40.8%) ended up on polytherapy. Patients remained significantly longer on lamotrigine (mean = 2.8 years, median = 3.1 years) compared to levetiracetam (mean = 2.0 years, median = 1.5 years) as a first prescribed medication (hazard ratio = 1.5, 95% confidence interval = 1.0-2.2). As the study progressed, the proportion of patients on lamotrigine, carbamazepine, and oxcarbazepine as well as other sodium channel agents increased from a little more than one third (154, 34.8%) of patients to more than two thirds (303, 68.4%) of patients.

Significance: Slightly more than one third of focal epilepsy patients remain on monotherapy with their first prescribed ASM. Approximately three in five patients transition to monotherapy with another ASM, whereas approximately two in five end up on polytherapy. Patients remain on lamotrigine for a longer duration compared to levetiracetam when it is prescribed as the initial monotherapy.

Keywords: natural history; polytherapy; sequential monotherapy.

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Conflict of interest statement

B.G. has been a consultant for Eisai, SK-Life Science, Aquestive, and UCB; and has received speaking honoraria from Eisai, SK Life Science, and Jazz. P.K. has received grant support from the Department of Defense/Citizens United for Research in Epilepsy and National Institute of Neurological Disorders and Stroke (NINDS); has served as a paid consultant, advisory board member, or speaker for Arvelle, Angelini, Aquestive, Biogen, Eisai, Engage Therapeutics, Greenwich Pharmaceuticals, Lundbeck, Neurelis, SK Life Science, Stratus, Sunovion, UCB Pharma, and UniQure; is a member of a scientific advisory board for OB Pharma; and is the CEO of PrevEp. B.W.A.-K. has received research support from Biogen, Cerevel, Otsuka, SK Life Science, Sunovion, UCB Pharma, and Xenon. J.Fr. receives salary support from the Epilepsy Foundation and for consulting work and/or attending scientific advisory boards on behalf of the Epilepsy Study Consortium for Aeonian/Aeovian, Alterity Therapeutics Limited, Anavex, Arkin Holdings, Angelini Pharma, Arvelle Therapeutics, Athenen Therapeutics/Carnot Pharma, Autifony Therapeutics Limited, Baergic Bio, Biogen, Biohaven Pharmaceuticals, BioMarin Pharmaceutical, BioXcel Therapeutics, Bloom Science, BridgeBio Pharma, Camp4 Therapeutics Corporation, Cerebral Therapeutics, Cerevel, Clinical Education Alliance, Coda Biotherapeutics, Corlieve Therapeutics, Eisai, Eliem Therapeutics, Encoded Therapeutics, Engage Therapeutics, Engrail, Epalex, Epihunter, Epiminder, Epitel, Equilibre BioPharmaceuticals, Greenwich Biosciences, Grin Therapeutics, GW Pharma, Janssen Phamaceutica, Jazz Pharmaceuticals, Knopp Biosciences, Lipocine, LivaNova, Longboard Pharmaceuticals, Lundbeck, Marinus, Mend Neuroscience, Marck, NeuCyte, Neumirna Therapeutics, Neurocrine, Neuroelectives USA Corporation, Neuronetics, Neuropace, NxGen Medicine, Ono Pharmaceutical, Otsuka Pharmaceutical Development, Ovid Therapeutics, Paladin Labs, Passage Bio, Pfizer, Praxis, Pure Tech LTY, Rafa Laboratories, SK Life Sciences, Sofinnova, Stoke, Supernus, Synergia Medical, Takeda, UCB, Ventus Therapeutics, Xenon, Xeris, Zogenix, and Zynerba. J.Fr. also has received research support from the Epilepsy Study Consortium (funded by Andrews Foundation, Eisai, Engage, Lundbeck, Pfizer, SK Life Science, Sunovion, UCB, and Vogelstein Foundation), the Epilepsy Study Consortium/Epilepsy Foundation (funded by UCB), GW/FACES, and NINDS. She is on the editorial boards of Lancet Neurology and Neurology Today. She is Chief Medical/Innovation Officer of the Epilepsy Foundation. She has received travel reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, Angelini Pharma, Clinical Education Alliance, NeuCyte, Neurocrine, Praxis, and Xenon. None of the other authors has any conflict of interest to disclose.

References

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