Departments of Neurology, Division of Health Outcomes and Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Departments of Population Health and Policy, Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Epilepsia. 2024 Nov;65(11):3216-3223. doi: 10.1111/epi.18133. Epub 2024 Sep 28.
Epilepsy is primarily treated with antiseizure medications (ASMs). The recommendations for first ASM in newly diagnosed epilepsy are inconsistently followed, and we sought to examine whether nonrecommended first ASM was associated with acute care utilization.
We conducted a retrospective cohort study of adults (≥18 years old) with newly diagnosed epilepsy (identified using validated epilepsy/convulsion International Classification of Diseases, Clinical Modification codes) in 2015-2019, sampled from Marketscan's Commercial and Medicare Databases. Exposure of interest was receipt of a non-guideline-recommended ASM, and the primary outcome was acute care utilization (an emergency department visit or hospitalization after the first ASM claim). Descriptive statistics characterized covariates, and multivariable negative binominal regression models were built adjusting for age, sex, Elixhauser Comorbidity Index, comorbid neurologic disease (e.g., stroke), and ASM polypharmacy.
Approximately 14 681 people with new epilepsy were prescribed an ASM within 1 year. The three most prescribed medications were levetiracetam (54%, n = 7912), gabapentin (10%, n = 1462), and topiramate (7%, n = 1022). Approximately 4% (n = 648) were prescribed an ASM that should be avoided, and ~74% of people with new epilepsy had an acute care visit during the follow-up period. Mean number of acute care visits during follow-up was 3.34 for "recommended" ASMs and 4.42 for ASMs that "should be avoided." Prescription of a recommended/neutral ASM as compared to an ASM that should be avoided was associated with reduced likelihood of acute care utilization (incidence rate ratio [IRR] = .85, 95% confidence interval [CI] = .77-.94). The recommended/neutral category of ASMs was not statistically significantly associated with seizure- or epilepsy-specific acute care utilization (IRR = .93, 95% CI = .79-1.09).
Adults with new epilepsy are frequent users of acute care. There remain a proportion of persons with epilepsy prescribed ASMs that guidelines suggest avoiding, and these ASMs are associated with increased likelihood of emergency department visit or hospitalization. These findings reinforce the importance of optimizing the choice of first ASM in epilepsy.
癫痫主要采用抗癫痫药物（ASM）治疗。对于新诊断癫痫的首选用药建议并未得到一致遵循，我们旨在探讨非推荐的首选用药是否与急性医疗资源利用相关。
我们对 2015 年至 2019 年期间市场扫描商业和医疗保险数据库中使用经过验证的癫痫/抽搐国际疾病分类、临床修正版代码诊断为新发癫痫的成年人（≥18 岁）进行了回顾性队列研究。感兴趣的暴露因素为接受非指南推荐的 ASM，主要结局为急性医疗资源利用（即首选用药后发生的急诊就诊或住院）。描述性统计分析了协变量特征，并采用多变量负二项回归模型，调整了年龄、性别、Elixhauser 合并症指数、合并神经系统疾病（如中风）和 ASM 多种药物治疗。
大约 14681 名新发癫痫患者在 1 年内开具了 ASM。最常开具的三种药物分别为左乙拉西坦（54%，n=7912）、加巴喷丁（10%，n=1462）和托吡酯（7%，n=1022）。约 4%（n=648）的患者开具了应避免使用的 ASM，且约 74%的新发癫痫患者在随访期间有急性医疗就诊。随访期间，“推荐”ASM的平均急性医疗就诊次数为 3.34 次，“应避免”的 ASM 为 4.42 次。与使用应避免的 ASM 相比，使用推荐/中性 ASM 与急性医疗资源利用的可能性降低相关（发生率比[IRR]为 0.85，95%置信区间[CI]为 0.77-0.94）。推荐/中性类别的 ASM 与癫痫或癫痫特异性急性医疗资源利用无统计学显著相关性（IRR 为 0.93，95%CI 为 0.79-1.09）。
新发癫痫的成年人是急性医疗资源的高频使用者。仍有一部分癫痫患者开具了指南建议避免使用的 ASM，这些 ASM 与急诊就诊或住院的可能性增加相关。这些发现强调了优化癫痫患者首选用药选择的重要性。
