Abstract

BackgroundAntiseizure medications (ASMs) are among the most commonly prescribed teratogenic drugs in women of childbearing age. Limited data exists on utilization patterns across different indications for therapy and for the newer generation ASMs in this population. Thus, we assessed the pattern of ASM use in women of childbearing age with epilepsy and non-epilepsy indications (pain and psychiatric disorders).MethodsWe conducted a retrospective analysis of deidentified administrative data submitted to the Optum Clinformatics database. Eligible subjects included women aged 12 - 50 years old that filled ASMs between year 2011-2017. Subjects were followed from date of index prescription filled to study end or insurance disenrollment, whichever came first. For the overall cohort and potential therapy indications, we assessed the type and frequency of antiseizure medications filled; proportion of subjects on monotherapy, polytherapy, or treatment switching; and duration of continuous use. Trends were characterized using annual percent change from study start to study end.ResultsOur analysis included 465,131 subjects who filled 603,916 distinct antiseizure medications prescriptions. At baseline, the majority of subjects had chronic pain (51.0%) and psychiatric disorders (32.7%), with epilepsy the least common (0.9%). The most frequently dispensed were diazepam (24.3%), lorazepam (20.1%), gabapentin (17.4%), clonazepam (12.7%), topiramate (11.3%), and lamotrigine (4.6%). Significant linear increase in trends were observed with gabapentin (annual percent change [95% CI]: 8.4 [7.3, 9.4]; p-value: < 0.001) and levetiracetam (3.4 [0.7, 6.2]; p-value: 0.022), and decreasing trends for diazepam (-3.5 [-2.4, - 4.5]; p-value: < 0.001) and clonazepam (-3.4 [-2.3, - 4.5]; p-value: 0.001). No significant change in trend was observed with valproate (-0.4 [-2.7, 1.9]; p-value: 0.651), while non-linear changes in trends were observed with lorazepam, topiramate, lamotrigine, and pregabalin.DiscussionDecreasing trends were observed with older antiseizure medications in the overall cohort and across the potential indications for therapy. Conversely, increasing trends were seen with the newer antiseizure medications. Considering the risk of teratogenicity associated with the newer medications largely unknown, counseling and education in addition to a careful consideration of the benefits versus potential risks should remain pivotal when prescribing antiseizure medications for women of childbearing age.

View details for DOI 10.1212/WNL.0000000000207580

View details for PubMedID 37407266