Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Epilepsia. 2021 Sep;62(9):2123-2132. doi: 10.1111/epi.16987. Epub 2021 Jul 9.
The first antiseizure medication (ASM) is ineffective or intolerable in 50% of epilepsy cases. Selection between more than 25 available ASMs is guided by epilepsy factors, but also age and comorbidities. Randomized evidence for particular patient subgroups is seldom available. We asked whether register data could be used for retention rate calculations based on demographics, comorbidities, and ASM history, and quantified the potential improvement in retention rates of the first ASM in several large epilepsy cohorts. We also describe retention rates in patients with epilepsy after traumatic brain injury and dementia, patient groups with little available evidence.
We used medical, demographic, and drug prescription data from epilepsy cohorts from comprehensive Swedish registers, containing 6380 observations. By analyzing 381 840 prescriptions, we studied retention rates of first- and second-line ASMs for patients with epilepsy in multiple sclerosis (MS), brain infection, dementia, traumatic brain injury, or stroke. The rank of retention rates of ASMs was validated by comparison to published randomized control trials. We identified the optimal stratification for each brain disease, and quantified the potential improvement if all patients had received the optimal ASM.
Using optimal stratification for each brain disease, the potential improvement in retention rate (percentage points) was MS, 20%; brain infection, 21%; dementia, 14%; trauma, 21%; and stroke, 14%. In epilepsy after trauma, levetiracetam had the highest retention rate at 80% (95% confidence interval [CI] = 65-89), exceeding that of the most commonly prescribed ASM, carbamazepine (p = .04). In epilepsy after dementia, lamotrigine (77%, 95% CI = 68-84) and levetiracetam (74%, 95% CI = 68-79) had higher retention rates than carbamazepine (p = .006 and p = .01, respectively).
We conclude that personalized ASM selection could improve retention rates and that national registers have potential as big data sources for personalized medicine in epilepsy.
在 50%的癫痫病例中，第一种抗癫痫药物（ASM）无效或无法耐受。在 25 种以上可用的 ASM 之间进行选择，不仅要考虑癫痫因素，还要考虑年龄和合并症。针对特定患者亚组的随机证据很少。我们想知道是否可以基于人口统计学、合并症和 ASM 病史使用登记数据来计算保留率，并量化在几个大型癫痫队列中，第一个 ASM 的保留率的潜在提高。我们还描述了颅脑损伤和痴呆后癫痫患者的保留率，这是两个证据较少的患者群体。
我们使用来自瑞典综合登记处的癫痫队列的医疗、人口统计学和药物处方数据，包含 6380 个观察值。通过分析 381840 张处方，我们研究了多发性硬化症（MS）、脑感染、痴呆、颅脑损伤或中风患者中一线和二线 ASM 的保留率。通过与已发表的随机对照试验进行比较，验证了 ASM 保留率的排名。我们确定了针对每种脑部疾病的最佳分层，并量化了如果所有患者都接受了最佳 ASM，保留率可能会提高多少。
使用针对每种脑部疾病的最佳分层，保留率（百分点）的潜在提高为 MS，提高 20%；脑感染，提高 21%；痴呆，提高 14%；创伤，提高 21%；中风，提高 14%。在颅脑损伤后的癫痫中，左乙拉西坦的保留率最高，为 80%（95%置信区间[CI] = 65-89），超过了最常开的 ASM 卡马西平（p=0.04）。在痴呆后的癫痫中，拉莫三嗪（77%，95%CI=68-84）和左乙拉西坦（74%，95%CI=68-79）的保留率高于卡马西平（p=0.006 和 p=0.01）。
我们的结论是，个性化 ASM 选择可以提高保留率，国家登记处有可能成为癫痫个性化医学的大数据来源。
