Jacob Louis, Hamer Hajo M, Kostev Karel
Faculty of Medicine, University of Paris 5, Paris, France.
Department of Neurology, Epilepsy Center, University of Erlangen, Germany.
Epilepsy Behav. 2017 Aug;73:204-207. doi: 10.1016/j.yebeh.2017.06.008. Epub 2017 Jun 23.
The goal of this study was to analyze the persistence with antiepileptic drugs (AED) and associated factors in patients followed in neurological practices in Germany.
This study included patients aged 18years or over who received two initial diagnoses of epilepsy and a first prescription of AED between 2007 and 2015 in a neurological practice (index date). The main outcome measure was the rate of AED persistence within five years of the index date. Kaplan-Meier analyses were performed to study treatment persistence as a function of age. A Cox proportional hazards regression model was used to estimate the relationship between non-persistence and demographic/clinical variables.
A total of 8192 patients followed in neurological practices were included. After five years of follow-up, 41.1% (≤40years), 45.2%, (41-60years) and 50.1% (>60years) of patients followed in neurological practices were persistent (log-rank p-value<0.001). A negative association was found between discontinuation and age (≤40years vs. >60years: OR=1.19, 95% CI: 1.09-1.31; 41-60years vs. >60years: OR=1.10, 95% CI: 1.01-1.19). Furthermore, patients receiving old AED (OR=1.16, 95% CI: 1.01-1.34) or gabapentin (OR=1.46, 95% CI: 1.16-1.83) and those diagnosed with depression (OR=1.12, 95% CI: 1.03-1.21) were at a higher risk of non-persistence, whereas those receiving levetiracetam (OR=0.69, 95% CI: 0.60-0.80) or lamotrigine (OR=0.88, 95% CI: 0.79-0.97) and those with dementia (OR=0.74, 95% CI: 0.65-0.83) were at a lower risk.
The rate of epilepsy patients persistent with AED was low after five years of treatment. Age, gender, co-morbidities, and drug characteristics were associated with this persistence.
本研究的目的是分析德国神经科诊所随访患者使用抗癫痫药物（AED）的持续性及相关因素。
本研究纳入了2007年至2015年期间在神经科诊所首次诊断为癫痫并首次开具AED处方（索引日期）的18岁及以上患者。主要结局指标是索引日期后五年内AED的持续使用率。采用Kaplan-Meier分析研究治疗持续性与年龄的关系。使用Cox比例风险回归模型估计停药与人口统计学/临床变量之间的关系。
共纳入了8192名在神经科诊所随访的患者。随访五年后，神经科诊所中年龄≤40岁的患者有41.1%、41 - 60岁的患者有45.2%、>60岁的患者有50.1%持续使用AED（对数秩检验p值<0.001）。停药与年龄之间存在负相关（≤40岁与>60岁相比：OR = 1.19，95%CI：1.09 - 1.31；41 - 60岁与>60岁相比：OR = 1.10，95%CI：1.01 - 1.19）。此外，使用旧AED（OR = 1.16，95%CI：1.01 - 1.34）或加巴喷丁（OR = 1.46，95%CI：1.16 - 1.83）的患者以及被诊断为抑郁症的患者（OR = 1.12，95%CI：1.03 - 1.21）停药风险较高，而使用左乙拉西坦（OR = 0.69，95%CI：0.60 - 0.80）或拉莫三嗪（OR = 0.88，95%CI：0.79 - 0.97）的患者以及患有痴呆症的患者（OR = 0.74，95%CI：0.65 - 0.83）停药风险较低。
癫痫患者接受AED治疗五年后的持续率较低。年龄、性别、合并症和药物特性与这种持续性有关。
