Department of Neurology, Stanford University School of Medicine, Palo Alto, California.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
JAMA Neurol. 2019 Jul 1;76(7):783-790. doi: 10.1001/jamaneurol.2019.0447.
Limited population-based data are available on antiepileptic drug (AED) treatment patterns in women of childbearing age with epilepsy; the current population risk is not clear.
To examine the AED treatment patterns and identify differences in use of valproate sodium and topiramate by comorbidities among women of childbearing age with epilepsy.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study used a nationwide commercial database and supplemental Medicare as well as Medicaid insurance claims data to identify 46 767 women with epilepsy aged 15 to 44 years. The eligible study cohort was enrolled between January 1, 2009, and December 31, 2013. Data analysis was conducted from January 1, 2017, to February 22, 2018.
Cases required an International Classification of Diseases, Ninth Revision, Clinical Modification-coded epilepsy diagnosis with continuous medical and pharmacy enrollment. Incident cases required a baseline of 2 or more years without an epilepsy diagnosis or AED prescription before the index date. For both incident and prevalent cases, focal and generalized epilepsy cohorts were matched by age, payer type, and enrollment period and then compared.
Antiepileptic drug treatment pattern according to seizure type and comorbidities.
Of the 46 767 patients identified, there were 8003 incident cases (mean [SD] age, 27.3 [9.4] years) and 38 764 prevalent cases (mean [SD] age, 29.7 [9.0] years). Among 3219 women in the incident epilepsy group who received AEDs for 90 days or more, 3173 (98.6%) received monotherapy as first-line treatment; among 28 239 treated prevalent cases, 18 987 (67.2%) received monotherapy. In 3544 (44.3%) incident cases and 9480 (24.5%) prevalent cases, AED treatment was not documented during 180 days or more of follow-up after diagnosis. Valproate (incident: 35 [5.81%]; prevalent: 514 [13.1%]) and phenytoin (incident: 33 [5.48%]; prevalent: 178 [4.53%]) were more commonly used for generalized epilepsy and oxcarbazepine (incident: 53 [8.03%]; prevalent: 386 [9.89%]) was more often used for focal epilepsy. Levetiracetam (incident: focal, 267 [40.5%]; generalized, 271 [45.0%]; prevalent: focal, 794 [20.3%]; generalized, 871 [22.2%]), lamotrigine (incident: focal, 123 [18.6%]; generalized, 106 [17.6%]; prevalent: focal, 968 [24.8%]; generalized, 871 [22.2%]), and topiramate (incident: focal, 102 [15.5%]; generalized, 64 [10.6%]; prevalent: focal, 499 [12.8%]; generalized, 470 [12.0%]) were leading AEDs prescribed for both focal and generalized epilepsy. Valproate was more commonly prescribed for women with comorbid headache or migraine (incident: 53 of 1251 [4.2%]; prevalent: 839 of 8046 [10.4%]), mood disorder (incident: 63 of 860 [7.3%]; prevalent: 1110 of 6995 [15.9%]), and anxiety and dissociative disorders (incident: 57 of 881 [6.5%]; prevalent: 798 of 5912 [13.5%]). Topiramate was more likely prescribed for those with comorbid headache or migraine (incident: 335 of 1251 [26.8%]; prevalent: 2322 of 8046 [28.9%]).
Many women appear to be treated with valproate and topiramate despite known teratogenicity risks. Comorbidities may affect selecting certain AEDs despite their teratogenicity risks.
目前尚不清楚当前的人群风险，关于育龄期女性癫痫患者的抗癫痫药物（AED）治疗模式，基于人群的有限数据可用。
研究育龄期女性癫痫患者的 AED 治疗模式，并确定与共病相关的丙戊酸钠和托吡酯的使用差异。
设计、地点和参与者：本回顾性队列研究使用了全国商业数据库以及补充医疗保险和医疗补助保险索赔数据，确定了 46767 名年龄在 15 至 44 岁之间的癫痫女性患者。合格的研究队列于 2009 年 1 月 1 日至 2013 年 12 月 31 日期间入组。数据分析于 2017 年 1 月 1 日至 2018 年 2 月 22 日进行。
病例需要国际疾病分类，第九版，临床修正编码癫痫诊断，持续医疗和药物使用。发病病例需要基线至少 2 年没有癫痫诊断或 AED 处方，然后才能在索引日期。对于发病和流行病例，局灶性和全面性癫痫队列按年龄、付款人类型和入组期匹配，然后进行比较。
根据发作类型和共病的抗癫痫药物治疗模式。
在确定的 46767 名患者中，有 8003 名发病病例（平均[标准差]年龄，27.3[9.4]岁）和 38764 名流行病例（平均[标准差]年龄，29.7[9.0]岁）。在接受 AED 治疗 90 天或以上的 3219 名发病癫痫患者中，3173 名（98.6%）接受一线单药治疗；在 28239 名接受治疗的流行病例中，18987 名（67.2%）接受单药治疗。在 3544 名（44.3%）发病病例和 9480 名（24.5%）流行病例中，在诊断后 180 天或更长时间内未记录 AED 治疗。丙戊酸钠（发病：35 例[5.81%]；流行：514 例[13.1%]）和苯妥英（发病：33 例[5.48%]；流行：178 例[4.53%]）更常用于全面性癫痫，而奥卡西平（发病：53 例[8.03%]；流行：386 例[9.89%]）更常用于局灶性癫痫。左乙拉西坦（发病：局灶性，267 例[40.5%]；全面性，271 例[45.0%]；流行：局灶性，794 例[20.3%]；全面性，871 例[22.2%]）、拉莫三嗪（发病：局灶性，123 例[18.6%]；全面性，106 例[17.6%]；流行：局灶性，968 例[24.8%]；全面性，871 例[22.2%]）和托吡酯（发病：局灶性，102 例[15.5%]；全面性，64 例[10.6%]；流行：局灶性，499 例[12.8%]；全面性，470 例[12.0%]）是局灶性和全面性癫痫的主要 AED 处方。丙戊酸钠更常用于有头痛或偏头痛共病的女性（发病：1251 例中有 53 例[4.2%]；流行：8046 例中有 839 例[10.4%]）、心境障碍（发病：860 例中有 63 例[7.3%]；流行：6995 例中有 1110 例[15.9%]）和焦虑及分离障碍（发病：881 例中有 57 例[6.5%]；流行：5912 例中有 798 例[13.5%]）。托吡酯更有可能用于有头痛或偏头痛共病的女性（发病：1251 例中有 335 例[26.8%]；流行：8046 例中有 2322 例[28.9%]）。
尽管存在致畸风险，但许多女性似乎仍接受丙戊酸钠和托吡酯治疗。尽管存在致畸风险，但共病可能会影响选择某些 AED。
