Prophylactic Anti-seizure Medication Use in Patients Undergoing Brain Tumor Resection

Abstract number : 2.247
Submission category : 7. Anti-seizure Medications / 7C. Cohort Studies
Year : 2022
Submission ID : 2204545
Source : www.aesnet.org
Presentation date : 12/4/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:25 AM

Authors :
Se Ryeong Jang, MPH – Eisai Inc., Nutley, NJ, USA; Katherine Peters, MD, PhD, FAAN – Duke University School of Medicine, Durham, NC, USA; Leock Ngo, PhD – Eisai Inc., Nutley, NJ, USA; Marcia Morita Sherman, MD, PhD – Eisai Inc., Nutley, NJ, USA

Rationale: The American Academy of Neurology, the Society for Neuro-Oncology, and the European Association of Neuro-Oncology recommend against prophylactic anti-seizure medication (ASM) use in patients with newly diagnosed brain tumors that are seizure-naïve (Glantz 2000, Walbert 2021). Yet, studies leading up to 2017 show that most providers worldwide continue to prescribe a prophylactic ASM to newly diagnosed brain tumor patients that did not have seizures on presentation (Brouwers 2003, Siomin 2005, de Olivia 2014, Lapointe 2015, Dewan 2017). Therefore, we conducted a population-based cohort study to explore the effectiveness of prophylactic ASM in a real-world setting.

Methods: This retrospective population-level cohort analysis was conducted using the data collected up to June 1, 2022, from the TriNetX Dataworks - USA Network, which provided access to electronic medical records from more than 82 million patients from 50 healthcare organizations in the U.S. We identified 16,690 seizure-naïve patients with a record of brain tumor diagnosis who underwent brain surgery from 2012 to 2017. After propensity score matching for various baseline confounders, including tumor type, comorbidities, and prescription medications, we compared the hazards of seizure and mortality between those prescribed a prophylactic ASM and those who were not. Prophylactic ASM use was defined as the presence of at least one prescription for an ASM from 30 days before brain surgery and up to 30 days afterward. The brain surgery date was considered the index date for the analysis, and patients were followed up for five years.

Results: Of the 16,690 patients who had a brain surgery, 7,336 (44.0%) were prescribed a prophylactic ASM. From the eligible prophylaxis (n=7,336) and no prophylaxis (n=9,371) groups, 4,068 patients were considered for each group for the Kaplan-Meier analyses after propensity score matching at a 1:1 ratio. ASM prophylaxis was associated with an increased hazard of developing a seizure during the 5-year follow-up period (Hazard Ratio: 2.90 [95% CI: 2.60, 3.23]) (Figure 1). Of the 4,068 patients, 1,118 of those on prophylaxis (27.5%) and 452 patients that were not prophylaxis (11.1%) developed a seizure during the follow-up period (p < 0.0001). Mortality hazard was 1.16 times (95% CI: 1.08, 1.25) higher in those on prophylaxis (Figure 2).
Anti-seizure Medications