Birmingham, AL—Older antiepileptic drugs (AEDs) appear to be most commonly used in Medicare beneficiaries with newly diagnosed epilepsy in the U.S., according to a new study.
The report in the journal Epilepsia also points out that only half of the older adults begin treatment with any AED within the first 30 days of a potential epilepsy diagnosis.
To determine that, University of Alabama at Birmingham researchers and colleagues analyzed Medicare administrative claims occurring between 2008 to 2010 for a 5% random sample of beneficiaries, augmented for minority representation. No major racial/ethnic disparities in AED prescription patterns were uncovered, however.
“In this population of older adults on Medicare Part D drug coverage, we noted that while prescriptions of newer-line AEDs, in particular levetiracetam, are increasing compared with other studies of older Americans with epilepsy, there remains a substantial proportion receiving older-line AEDs, most notably phenytoin,” said senior author Maria Pisu, PhD. “We cannot assess why this occurs from these data, but the use of newer AEDs with more favorable side-effect potential and lower risk for drug-drug interactions is particularly important in an older population with a significant number of co-occurring conditions.”
Over 1 year of follow-up, 79.6% of 3,706 new epilepsy cases had one AED only (77.89% of whites vs. 89% of American Indian/Alaska Native [AI/AN]), with levetiracetam the most commonly prescribed AED at 45.5%. The second most common was phenytoin at 30.6%.
At the same time, only 50% received prompt AED therapy—49.6% whites to 53.9% AI/AN—although race/ethnicity was not significantly associated with AED patterns, monotherapy use, or prompt treatment, according to the researchers.
“Monotherapy is common across all racial/ethnic groups of older adults with new-onset epilepsy, older AEDs are commonly prescribed, and treatment is frequently delayed,” study authors write. “Further studies on reasons for treatment delays are warranted. Interventions should be developed and tested to develop paradigms that lead to better care.”
Pisu noted that the study’s main interest was in assessing differences in treatment across racial/ethnic groups because disparities in epilepsy care have been reported before, and some groups may disproportionately suffer from the consequences of suboptimal epilepsy treatment.
“We found, however, that minority groups seem to receive comparable AED treatment to whites despite clear socioeconomic differences with the white counterparts,” she explained.
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Published February 22, 2017