Chen Siming, Fukasawa Toshiki, Ikeda Akio, Takeuchi Masato, Shimotake Akihiro, Yoshida Satomi, Kawakami Koji
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Heliyon. 2023 Mar 29;9(4):e15017. doi: 10.1016/j.heliyon.2023.e15017. eCollection 2023 Apr.
We evaluated adherence to and 1-year persistence of two third-generation anti-seizure medications (ASMs), lacosamide and perampanel, in adult patients with focal epilepsy, compared with lamotrigine and levetiracetam.
A cohort study was conducted using a Japanese health insurance claims database (JMDC Inc.). We identified patients with adult-onset focal epilepsy who initiated any of the four ASMs between August 31, 2016, and October 31, 2019. Patients were further classified into ASM-naïve patients initiating any of the four ASMs as first-line treatment, and ASM-experienced patients initiating any of the four ASMs as second- or later-line treatment. Outcomes included adherence (proportion of days covered [PDC], defined as the total number of days covered by ASMs divided by the total number of days in the follow-up period) and 1-year persistence for the four ASMs.
We identified 141 lacosamide, 75 perampanel, 80 lamotrigine, and 530 levetiracetam initiators. Among these, the proportion of ASM-naïve patients was highest in the levetiracetam group (60.8%), followed by the lamotrigine (25.0%), lacosamide (20.6%), and perampanel groups (1.3%). Mean PDC (standard deviation) was similar across the four groups, at 0.95 (0.08) for lacosamide, 0.93 (0.12) for perampanel, 0.92 (0.10) for lamotrigine and 0.94 (0.11) for levetiracetam. The proportion of patients persisting with treatment for 1 year was highest in the lacosamide group (73.0%), followed by the levetiracetam (58.3%), lamotrigine (57.5%), and perampanel groups (54.7%). In ASM-naïve patients, adherence and 1-year persistence were almost identical in the lacosamide, lamotrigine, and levetiracetam groups. Results for ASM-experienced patients did not significantly differ from those of all patients.
With regard to adherence and 1-year persistence, lacosamide may be equal to or better than lamotrigine and levetiracetam, especially in patients with experienced ASM, while perampanel may be comparable to lamotrigine and levetiracetam in patients with experienced ASM.
我们评估了第三代抗癫痫药物（ASM）拉科酰胺和吡仑帕奈在成人局灶性癫痫患者中的依从性和1年持续用药率，并与拉莫三嗪和左乙拉西坦进行比较。
使用日本医疗保险索赔数据库（JMDC公司）进行了一项队列研究。我们确定了在2016年8月31日至2019年10月31日期间开始使用四种ASM中的任何一种的成人起病局灶性癫痫患者。患者进一步分为初治患者（将四种ASM中的任何一种作为一线治疗开始用药）和经治患者（将四种ASM中的任何一种作为二线或更晚线治疗开始用药）。结局指标包括依从性（覆盖天数比例[PDC]，定义为ASM覆盖的总天数除以随访期的总天数）和四种ASM的1年持续用药率。
我们确定了141名拉科酰胺起始使用者、75名吡仑帕奈起始使用者、80名拉莫三嗪起始使用者和530名左乙拉西坦起始使用者。其中，左乙拉西坦组初治患者的比例最高（60.8%），其次是拉莫三嗪组（25.0%）、拉科酰胺组（20.6%）和吡仑帕奈组（1.3%）。四组的平均PDC（标准差）相似，拉科酰胺为0.95（0.08），吡仑帕奈为0.93（0.12），拉莫三嗪为0.92（0.10），左乙拉西坦为0.94（0.11）。拉科酰胺组持续治疗1年的患者比例最高（73.0%），其次是左乙拉西坦组（58.3%）、拉莫三嗪组（57.5%）和吡仑帕奈组（54.7%）。在初治患者中，拉科酰胺、拉莫三嗪和左乙拉西坦组的依从性和1年持续用药率几乎相同。经治患者的结果与所有患者的结果无显著差异。
在依从性和1年持续用药率方面，拉科酰胺可能等于或优于拉莫三嗪和左乙拉西坦，尤其是在有ASM使用经验的患者中，而吡仑帕奈在有ASM使用经验的患者中可能与拉莫三嗪和左乙拉西坦相当。
