Authors :
Hervé Besson, PhD – UCB Pharma, Breda, Netherlands
Anna Kuba, MSc – UCB Pharma, Warsaw, Poland
Brian Moseley, MD – UCB Pharma, Morrisville, NC, USA
Beade Numbere, PhD – UCB Pharma, Slough, England, UK
Presenting Author: Kristy Pucylowski, PharmD – UCB Pharma, Smyrna, GA, USA
Allison Little, PharmD – UCB Pharma, Smyrna, GA, USA
Dimitrios Bourikas, PhD – UCB Pharma, Alimos, Greece
Rationale: Brivaracetam (BRV) is approved as monotherapy for focal-onset seizures in the United States; however, BRV monotherapy real-world data are limited. The objective of this data claims study was to assess patient characteristics, treatment patterns, and epilepsy/seizure-related healthcare resource utilization (HCRU) in patients with epilepsy who initiated BRV monotherapy.
Methods: Retrospective analysis of de-identified data from Merative MarketScan of patients with an epilepsy/seizure diagnosis (ICD-9 345.X/780.39; ICD-10 G40.X/R56.9) restricted to BRV monotherapy, with medical/pharmacy benefits for 12 months before and ≥ 90 days after index (shorter pre-index period for patients < 12 months of age). BRV monotherapy was defined as patients with a BRV pharmacy claim (date of first BRV claim during the identification period [01/01/2016–12/31/2020] = index date) with antiseizure medications (ASMs) prescribed before BRV initiation discontinued < 90 days after BRV initiation, and no claim for other ASM within 90 days after BRV initiation. HCRU (hospitalizations, intensive care unit [ICU] visits, emergency department [ED] visits, and outpatient [OP] neurology visits) were captured 12 months before (baseline) and after first BRV prescription (follow-up; ranging from 3-12 months).
Results: 594 patients (mean age 32.9 years; 56.9% female) were identified (Table 1). 105 (17.7%), 471 (79.3%), and 18 (3.0%) patients were < 16, 16–64, and ≥ 65 years of age, respectively. During baseline, 48.5%, 23.7%, and 27.8% of patients had focal-onset, only generalized-onset, and undefined seizure type, respectively. In the year before BRV initiation, 91.6% were taking ≥1 ASM (94.3%, 90.9%, and 94.4% of patients < 16, 16–64, and ≥ 65 years of age, respectively), with levetiracetam being the most frequently initiated last ASM before BRV initiation (overall and for all age groups). 81.3% of patients had > 365 days of follow-up (85.7%, 80.9%, and 66.7% of patients < 16, 16–64, and ≥ 65 years of age, respectively). At 12-month follow-up, 31.5% of patients remained on BRV monotherapy (33.3%, 30.6%, and 44.4% of patients < 16, 16–64, and ≥ 65 years of age, respectively). The Kaplan-Meier-estimated median time to BRV discontinuation was 369 days (Figure 1). Epilepsy/seizure-related HCRU decreased from baseline to follow-up (all patients, age < 16, 16–64, ≥ 65 years, hospitalizations: 15.5% to 7.9%, 13.3% to 8.6%, 16.1% to 8.1%, 11.1% to 0; ICU visits: 6.4% to 2.5%, 2.9% to 1.9%, 7.2% to 2.8%, 5.6% to 0; ED visits: 43.1% to 20.5%, 44.8% to 20.0%, 43.5% to 21.2%, 22.2% to 5.6%; OP neurology visits: 70.9% to 57.4%, 71.4% to 59.0%, 70.7% to 57.1%, 72.2% to 55.6%).
Conclusions: This retrospective data claims analysis demonstrated that retention on BRV monotherapy at 12 months was maintained by approximately a third of patients in all age groups. From baseline to 12-month follow-up and regardless of age, HCRU decreased for those patients who initiated BRV monotherapy, providing evidence that BRV monotherapy can potentially be useful for the treatment of seizures.
Funding: UCB Pharma-sponsored