Assessing the Utility of High Dose Prednisolone Compared to ACTH for the Treatment of Infantile Spasms
Abstract number :
2.261
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
475
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Leyla Farshidpour, MD – UCSF
Batool Hussain, MD – UC Davis Medical Center
Trishna Kantamneni, MD – UC Davis
Rationale: Infantile spasms is a severe epileptic encephalopathy of early childhood historically characterized by epileptic spasms, electroencephalographic (EEG) pattern of hypsarrhythmia and developmental delay or regression. Early diagnosis and treatment impact developmental outcomes. Currently, adrenocorticotropic hormone (ACTH) is the “preferred treatment” and oral corticosteroids (OCS) is identified as “probably effective” in children with etiologies other than Tuberous sclerosis, per ILAE. ACTH costs continue to rise with a 14 day course of treatment costing $100,457 in 2020, compared to oral prednisolone costing about $89 in 2020. ACTH is also often associated with a treatment delay in the real-world due to the need for insurance approvals and not being readily available at most pharmacies. In the United States, ACTH has been largely replaced with high dose (4-8 mg/kg/day) OCS in recent years due to fewer adverse side effects, significantly lower cost, and easy access. We aimed to compare treatment outcomes at our medical center before and after the change in practice from ACTH to high dose oral prednisolone.
Methods: Chart review was performed on 42 patients diagnosed with infantile spasms at a tertiary treatment center between the years of 2013 and 2022. The patients were divided into two groups, those seen before 2018 and those seen after 2018 when the pediatric neurology group came to a consensus to switch to high dose prednisolone (6-8 mg/kg/day or maximum of 60 mg/day) as first line of treatment. Patients that were treated with a medication other than ACTH or prednisolone were excluded. Time to treatment initiation, treatment response, time to treatment response, rates of relapse, and basic demographic information was compared between the two groups. Responders were defined as patients with resolution of clinical spasms as well as hypsarrhythmia on EEG at the end of treatment.
Results: Overall, the change in practice resulted in an earlier initiation of treatment, with a median of 3 days for the prednisolone group compared with a median of 8 days for the ACTH group. Rates of responders were 57% in the prednisolone group with a relapse rate of 9% and 60% in the ACTH group with a relapse rate of 50%. We also noticed that, interestingly, prior to 2018 those with government insurance (Medi-cal, California Children's Services) would take on average 11.25 days to start their medication compared with 6.5 days for private insurance. After 2018, this trend was reversed with government insurance taking only 5.5 days and private insurance 14 days to get their medications.
Conclusions: Our study portrays a benefit to starting treatment with high dose prednisolone as it is associated with earlier initiation of treatment, and significantly lower rates of relapse with similar treatment response rate when compared to ACTH while being more cost-effective.
Funding: No funding was obtained or used for this research project.
Clinical Epilepsy