Sánchez Fernández Iván, Amengual-Gual Marta, Barcia Aguilar Cristina, Khan Taha Fathima, Gaínza-Lein Marina, Torres Alcy, Rinat Jonas, Douglass Laurie
Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Epilepsia. 2025 Mar;66(3):648-661. doi: 10.1111/epi.18232. Epub 2025 Feb 1.
The proportion of patients with epilepsy who have a non-intravenous rescue benzodiazepine (non-IV-rBZD) available for seizure emergencies is unknown. This study aims to describe prescription patterns from 2006 to 2022, factors associated with prescription, and the impact of recently introduced intranasal benzodiazepines on prescription and cost.
Retrospective analysis of the MarketScan Database, a claims database of privately insured patients in the United States.
Among 213 384 patients (53% female, median (p-p) age: 33 (17-50) years) with epilepsy taking long-term anti-seizure medications with follow-up of 2.62 (1.54-4.73) years, only 30 371 patients (14.2%) had at least one non-IV-rBZD prescription. The proportion of patients with at least one non-IV-rBZD prescription was higher among: (1) younger patients (61.4% in the 0-5 year age group, 44.2% in the 6-12 year age group, 23.9% in the 13-21 year age group, 4.8% in the 22-35 year age group, 1.8% in the 36-50 year age group, 1.3% in the 51-60 year age group, and 1.0% in the older than 60 years age group); (2) patients with refractory epilepsy (24.3% vs 10.9% in non-refractory epilepsy); and (3) patients with more emergency department visits or hospital admissions for epilepsy (7.1% among patients with 0, 19.2% among patients with 1-3, and 31.1% among patients with more than 3). Multivariate analysis confirmed young age, refractory epilepsy, and emergency department visits or hospitalizations for epilepsy as strong independent predictors of having at least one non-IV-rBZD prescription. Prescriptions for intranasal midazolam and intranasal diazepam have increased rapidly; they had moderately increased the overall proportion of patients with a non-IV-rBZD prescription, whereas the inflation-adjusted cost of non-IV-rBZDs has markedly increased.
The vast majority of patients with epilepsy have not filled a prescription for non-IV-rBZDs. Seizure emergency readiness can be markedly improved, especially among adults. The cost of non-IV-rBZDs has increased with intranasal rescue medications.
癫痫患者中可获得用于癫痫发作紧急情况的非静脉注射急救苯二氮䓬类药物（非IV - rBZD）的比例尚不清楚。本研究旨在描述2006年至2022年的处方模式、与处方相关的因素以及最近引入的鼻内苯二氮䓬类药物对处方和成本的影响。
对MarketScan数据库进行回顾性分析，该数据库是美国私人保险患者的索赔数据库。
在213384例癫痫患者（53%为女性，中位（四分位间距）年龄：33（17 - 50）岁）中，服用长期抗癫痫药物且随访2.62（1.54 - 4.73）年，只有30371例患者（14.2%）至少有一张非IV - rBZD处方。至少有一张非IV - rBZD处方的患者比例在以下人群中较高：（1）年轻患者（0 - 5岁年龄组为61.4%，6 - 12岁年龄组为44.2%，13 - 21岁年龄组为23.9%，22 - 35岁年龄组为4.8%，36 - 50岁年龄组为1.8%，51 - 60岁年龄组为1.3%，60岁以上年龄组为1.0%）；（2）难治性癫痫患者（难治性癫痫患者为24.3%，非难治性癫痫患者为10.9%）；（3）因癫痫急诊就诊或住院次数较多的患者（0次就诊患者中为7.1%，1 - 3次就诊患者中为19.2%，3次以上就诊患者中为31.1%）。多变量分析证实年轻、难治性癫痫以及因癫痫急诊就诊或住院是至少有一张非IV - rBZD处方的强有力独立预测因素。鼻内咪达唑仑和鼻内地西泮的处方迅速增加；它们适度提高了有非IV - rBZD处方患者的总体比例，而经通胀调整后的非IV - rBZD成本显著增加。
绝大多数癫痫患者未开具非IV - rBZD的处方。癫痫发作应急准备情况可显著改善，尤其是在成年人中。随着鼻内急救药物的使用，非IV - rBZD的成本有所增加。
