Researchers Detail Time to Switch or Add-on for Patients on First-line AED
VANCOUVER, BC—Most patients on first-line antiepileptic drug (AED) monotherapy continue initial treatment for nearly 1 year, according to a retrospective database study reported at the 68th AAN Annual Meeting.
"After a median of 1.4 years of follow-up, 78.5% of patients received only initial AED monotherapy to the end of the follow-up; 9.8% switched to another monotherapy; 5.3% changed to polytherapy," reported lead study author Linda Kalilani, MD, of UCB Pharma in Raleigh, NC, and coauthors, in a research poster. "Almost half the patients received LEV [levetiracetam] as initial monotherapy."
“For those changing to another AED/polytherapy, switching occurred after approximately 6 months,” they reported. “Further study is warranted to better understand AED use and patient's clinical course preceding treatment modifications.”
Because there is limited information about long-term epilepsy treatment patterns, the coauthors evaluated AED treatment patterns during 2009 and 2013 using the commercial claims and supplemental Medicare (CCMC) insurance claims data from the Truven Health MarketScan database, using ILAE diagnostic guidelines.
“Overall, 38,674 cases were identified; of these, 16,246 were untreated and 22,428 received first-line treatment," the coauthors wrote. "Of 22,428 incident cases, 16,782 and 338 cases received first-line treatment with monotherapy or polytherapy, respectively; remaining cases had treatment records of <90 days.”
The most commonly-prescribed AEDs (>5% of patients) for first-line treatment were levetiracetam (n=10,422), phenytoin (n=1,552), lamotrigine (n=1,512), valproate (n=1,296), gabapentin (n=1,288), and topiramate (n=1,194).
The median time to switch from first-line AED monotherapy to polytherapy was 146.5 days; median time to add-on polytherapy from first-line monotherapy was 208 days. For patients who switched from initial monotherapy to second-line mono therapy, the median time to switch was 172 days.The study was funded by UCB Pharma.