Authors :
Presenting Author: Emily T. Klatte, MD – OhioHealth
Stern Sean, MS – SK Life Science, Inc.
Marc Kamin, MD – SK Life Science, Inc.
Clarence T. Wade, MBA – SK Life Science, Inc.
Wesley Kerr, MD, PhD – University of Pittsburgh Neurology
Rationale:
Cenobamate is an antiseizure medication (ASM) approved for adults in the US, Canada, and Europe that has demonstrated efficacy across focal seizure subtypes, including focal to bilateral tonic-clonic seizures. The aim of this study was to evaluate the comparative effect of initiating cenobamate vs selected ASMs (brivaracetam, clobazam, eslicarbazepine, lacosamide, or perampanel) on epilepsy-related and all-cause inpatient (IP) and emergency room (ER) utilization rates.Methods:
A retrospective observational study using de-identified electronic health records (EHRs) from 28 healthcare organizations representing ambulatory centers, hospitals, imaging centers, and clinics and medical offices (the Truveta database) identified adults (≥18 years) with an epilepsy diagnosis who initiated cenobamate or another selected ASM between January 1, 2020 and Dec 5, 2024. The other selected ASMs were chosen based on similar patterns of use primarily in medication-resistant epilepsy. Patients were included if they reached a minimum effective dose (100 mg for cenobamate, per US label for selected ASMs) and remained on treatment for ≥90 days after initiation. To address selection bias due to the length of titration with cenobamate, patients with an epilepsy-related ER visit or IP admission in the previous 180 days were excluded. The endpoints were the annual rate of epilepsy-related and all-cause ER visits and IP admissions. The endpoints were evaluated during the 90-day period after initiation and the subsequent 360-day period. Negative binomial regression models (adjusted for demographic and clinical covariables) were used to compare outcomes between the propensity-matched cohorts. Results:
The study sample contained a total of 1805 patients (mean age 41.4 years, 51.2% female), including 361 patients who initiated cenobamate and 1444 propensity-matched patients who initiated other selected ASMs. Propensity matching addressed multiple differences in clinical characteristics of patients who initiated cenobamate as compared to the other selected ASMs. In the epilepsy-related analysis, treatment with cenobamate was associated with a 48% reduction (95% CI: 29%-61%) vs the selected ASM group in annual IP admissions, and a 35% reduction (95% CI: 8%-54%) in the annual ER visits. In the all-cause analysis, treatment with cenobamate was associated with a 37% reduction (95% CI: 25%-48%) vs the select ASM group in annual IP admissions, and a 34% reduction (95% CI: 23%-43%) in the annual ER visits. Conclusions:
Initiation of cenobamate was associated with a significant reduction in both epilepsy-related and all-cause IP admissions and ER visits as compared to propensity-matched patients who similarly could likely have initiated cenobamate, but instead initiated other ASMs. The mechanism for why cenobamate was associated with fewer IP admissions and ER visits is challenging to evaluate with EHRs and could include both direct increases in seizure freedom rate and reduced seizure frequency, as well as nonseizure impacts.
Funding:
Funded by SK Life Science, Inc.