Abstracts

Rationale: Brivaracetam (BRV) was approved by the FDA in 2016 as a scheduled V controlled substance. The majority of states, including California, require monitoring of prescribing and dispensing of all scheduled drugs through prescription drug monitoring programs which can be used to obtain information on prescribing practices. BRV is reported to have lower incidence of side effects and less drug interactions compared to other antiseizure meds (ASMs) and has been touted to replace levetiracetam as the most commonly prescribed ASM. However, little is known about BRV use. The objective of this study was to use real-world prescribing and dispensing data obtained through the Controlled Substance Utilization Review and Evaluation System (CURES) to identify the trends of BRV use between 2019 and 2022 in California.


Methods: The CURES dataset was obtained from the California Department of Justice containing de-identified prescription dispensing data from 2019-2022 with IRB approval and analyzed using R Project for Statistical Computing (Version 4.2.1). All patients with at least one BRV prescription were identified. New and continuing patients on BRV were identified for each year with new patients being defined as patients who had no BRV prescriptions in the prior year. All patients with BRV prescription in 2019 were classified as new patients as no CURES data was available for the prior year. Patients were stratified by age, average dose per day, as well as by reported average household income based on ZIP code to evaluate for a possible effect of socioeconomic status (SES) on BRV use.


Results: The total number of patients on BRV continuously increased from 2019 to 2022 (2019: 731; 2020: 1,140; 2021: 3,849; 2022: 4,796) in California. The largest increase of 337% was seen in 2021 followed by a 30% increase in 2022. The rate of new BRV dispensing increased significantly in 2021 with 60% of all BRV patients being new patients and is sustained in 2022. The majority of BRV patients are age 27-64 (74%). Elderly and pediatric patients constitute a minority (13% each). Los Angeles (LA) County has the greatest number of BRV patients followed by San Diego, Orange, and San Bernardino Counties. In LA, there were relatively low levels of BRV dispensing across Q1-Q5 SES strata in 2019 and 2020 with significant increases in all strata in 2021, though most prominently in the Q4 and Q5 quintiles. Comparable increases in BRV dispensing continued across all strata in 2022.


Conclusions: BRV use continues to increase although most prominently in 2021. Although BRV is approved for ages 1 month and up, the majority of the patients receiving BRV are 27 years or older. In LA, BRV use is highest among the higher Q4/Q5 SES strata. Further studies are warranted to compare this data with other ASMs such as lacosamide, which is an established ASM and a controlled substance.


Funding: Dr. Patel and Dr. Yang are supported by NIGMS R35 (1R35GM131788-01).