Cerevel Therapeutics, Cambridge, MA, USA.
Analysis Group Inc., Boston, MA, USA.
Curr Med Res Opin. 2024 Oct;40(10):1727-1736. doi: 10.1080/03007995.2024.2396049. Epub 2024 Sep 2.
This study investigated clinical characteristics, burden of uncontrolled seizures, and seizure-related healthcare resource utilization (HRU) among individuals living with drug-resistant focal epilepsy (FE) in the United States (US).
Medical charts of adults with drug-resistant FE who initiated third-line (3 L) anti-seizure medication were extracted from clinical practices in the US (1/1/2013-1/31/2020). The index date, defined as the date of 3 L initiation, was used to indicate the emergence of drug resistance. Individuals on cenobamate were followed for any length of time from the index date. Demographic and clinical characteristics were analyzed descriptively. Primary clinical outcomes included seizure burden (i.e. change in seizure frequency and time to the first and second seizure events) and epilepsy-related HRU.
Overall, 189 neurologists/epileptologists contributed 345 charts of individuals living with drug-resistant FE (66% male; average age 24 years at diagnosis and 32 years at index date). 66% had ≥1 neurologic/neuropsychiatric comorbidity at baseline. Average monthly seizure rate decreased from 6.1 at baseline to 3.8 at follow-up; however, nearly half of individuals experienced worse/no change or only some improvement (<50% reduction) in seizure frequency. Most individuals (91%) had ≥1 epilepsy-related outpatient visit during follow-up. Unplanned HRU included emergency department visits (43%) and hospitalizations (24%), primarily due to breakthrough seizure events.
Despite the availability of many anti-seizure medications in the US, people living with drug-resistant FE continue to experience multiple seizures per month and incur substantial healthcare resources. Novel pharmacotherapies may help individuals living with drug-resistant epilepsy achieve seizure freedom.
本研究旨在调查美国（美国）耐药性局灶性癫痫（FE）患者的临床特征、未控制癫痫发作的负担以及与癫痫相关的医疗资源利用（HRU）。
从美国的临床实践中提取了开始使用三线（3L）抗癫痫药物的耐药性局灶性癫痫成人的病历（2013 年 1 月 1 日至 2020 年 1 月 31 日）。将索引日期（定义为 3L 开始的日期）定义为耐药性出现的时间。从索引日期起，任何时间都可以对服用cenobamate的患者进行随访。对人口统计学和临床特征进行描述性分析。主要临床结局包括癫痫发作负担（即癫痫发作频率的变化以及首次和第二次癫痫发作事件的时间）和与癫痫相关的 HRU。
总体而言，189 名神经病学家/癫痫学家贡献了 345 份耐药性局灶性癫痫患者的病历（66%为男性；诊断时的平均年龄为 24 岁，索引日期时的平均年龄为 32 岁）。基线时 66%有≥1 种神经/神经精神合并症。平均每月癫痫发作率从基线时的 6.1 下降到随访时的 3.8；然而，近一半的患者癫痫发作频率无改善/恶化或仅部分改善（<50%减少）。大多数患者（91%）在随访期间有≥1 次癫痫相关的门诊就诊。非计划 HRU 包括急诊就诊（43%）和住院治疗（24%），主要是由于突破性癫痫发作事件。
尽管美国有许多抗癫痫药物，但耐药性局灶性癫痫患者仍每月发作多次，并消耗大量医疗资源。新型药物治疗可能有助于耐药性癫痫患者实现无癫痫发作。
