Abstracts

Rationale: Limited long-term data are available on disease progression and patterns of antiepileptic drug (AED) treatment in epilepsy patients. Real-world data that follows the treatment progression of newly-diagnosed epilepsy patients will improve our understanding of current treatment patterns. We determined the patient characteristics, common comorbidities and AED treatment patterns in patients with new onset epilepsy in a US population followed for ≥6 months.Methods: In a retrospective cohort study, Commercial and Medicare [CC], and Medicaid insurance claims data from US-based Truven Health MarketScan claims database were analyzed for incident epilepsy cases with an index date between Jan 2010 and Jun 2013, and a prior baseline of 2 years (1 year for those aged 1 to <2 years; none for those <1 year). Cases were required to meet epilepsy criteria consistent with ILAE diagnostic guidelines, with continuous medical and pharmacy enrollment without an epilepsy or seizure diagnosis or AED prescription during the baseline period. Treatment was classified as monotherapy (1 AED for ≥90 continuous days) and polytherapy (≥2 AEDs for ≥90 days). Patients were classified as untreated in the absence of AED prescription claims during the follow-up period but having other pharmacy or healthcare claims. Comparisons of treatment patterns used matched cohorts across epilepsy seizure types.Results: Of 58,757 incident cases, 50,838 patients had a follow-up of ≥180 days. The mean (SD) duration of follow-up was 563.7 (257.0) days. Patient characteristics were similar across epilepsy seizure types (Table 1). Matched cases for comparison were available for focal vs general epilepsy (N=9,949 each), focal vs undefined epilepsy (N=11,077 each) and generalized vs undefined epilepsy (N=12,195 each). At 6 mo, 46.8% of patients had received AED treatment. Of 29,226 patients receiving treatment, 74.7% and 1.6% received monotherapy and polytherapy as 1st-line treatment; remaining patients received AED for <90 days and were excluded from analysis. Overall, the probability of remaining on initial treatment after 1 year was 61.0% and 36.5% for mono- and polytherapy. A higher probability of remaining on initial monotherapy was observed at 1 and 2 years with focal vs undefined epilepsy (P<0.05) and at 0.5, 1 and 2 years with generalized vs undefined epilepsy (P<0.05); focal vs generalized epilepsy cohorts were similar. The most common AEDs used for 1st-line treatment were levetiracetam (44.4%), phenytoin (6.5%), valproic acid (6.4%), lamotrigine (6.3%), and oxcarbazepine (5.7%). The majority of patients receiving lamotrigine (55.8%), oxcarbazepine (55.2%) and levetiracetam (51.5%) as initial AED remained on 1st-line treatment during the study. Initial AED and progression to 2nd-line treatments are illustrated in Table 2.Conclusions: Initial epilepsy treatment is usually with monotherapy, and the one-year persistence rate for 1st-line therapy is 61%. Treatment patterns appeared similar among focal and generalized epilepsy cohorts. UCB Pharma-sponsored.