Abstracts

Rationale: Epilepsy is controlled with a single antiseizure medication (ASM) in approximately 50% of children.¹ The SANAD II study demonstrated that lamotrigine (LTG) is an ideal agent for first line therapy in focal epilepsy and a Cochrane review identified that it is also a reasonable first-line option for generalized tonic-clonic seizures.^2,3 Many factors can influence prescribing practices, but recent studies examining treatment for infantile spasms have identified an impact of sociodemographic characteristics.⁴ We sought to examine the prescribing practices of ASMs over time, specifically LTG, and to identify associations of non-epilepsy related social factors that could impact receiving evidence based therapy.


Methods: Data were extracted from the nationwide Epic electronic health record database, Cosmos, via SQL query from 2015-2022. International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes beginning with G40.* were used to define the patient cohort of children with epilepsy (CWE) aged 4-18 years. Those with a diagnosis of childhood absence epilepsy (G40.A01, A09, A19, or 309) were excluded from the analysis. Monotherapies were aggregated into LTG vs. all others. Multivariable logistic regression was used to model the odds of a LTG prescription. Model calibration was evaluated with the Hosmer-Lemeshow test and discrimination was evaluated via area under the curve (AUC) of the receiver operating characteristic (ROC) curve.


Results: This cross-sectional cohort study included 75,672 CWE (56% male) with a single active ASM prescription. The racial composition was 56% White and 20% Black. 17% were of Hispanic ethnicity. All 4 quartiles of SVI were represented, and 30% had public insurance. Levetiracetam was the most common medication prescribed (54%) and only 7.3% received LTG. The use of these medications over the time period investigated is displayed in Figure 1. On multivariable modeling, the odds of having a prescription for LTG continually declined when compared to that of the initial year of 2015 (p< 0.001). Lower odds of a LTG prescription were also associated with a higher SVI (p< 0.001), Black and Asian race (p< 0.001) (Figure 2), Hispanic/Latino ethnicity (p< 0.001), and Male sex (p< 0.0001).


Conclusions: CWE across the United States are being treated with LTG monotherapy at lower rates than in 2015 despite published evidence of its effectiveness over other commonly used ASMs. This trend in prescribing practices is more prominent in racial and ethnic minorities and those with higher social vulnerability.



Data used in this study came from Epic Cosmos, a data set created in collaboration with a community of Epic Health systems representing more than 249 million patient records from over 1,412 hospitals from all 50 states and Lebanon.

References

1. PMID 19889013

2. PMID 33838757

3. PMID 35363878

4. PMID 35388521


Funding: This study was supported by Award Number 45141-0001-0321 from

Nationwide Children’s Hospital.