Antiepileptic drug treatment patterns and economic burden of commercially-insured patients with refractory epilepsy with partial onset seizures in the United States

Abstract

Pattern of use was very dynamic, suggesting seizures are not well-controlled. Improving seizure control and reducing economic burden of refractory epilepsy remain important unmet medical needs in this population.

Trends in Antiepileptic Drug Prescriptions for Childhood Epilepsy at a Tertiary Children’s Hospital in Korea, 2001–2012

“…Contrary to the findings in the overall population, for children receiving their initial prescription for epilepsy, monotherapy was used in about 83.9 % of cases and valproic acid was the most widely used AED, findings that are consistent with the previous report and guideline [27].…”

“…Although levetiracetam is a popular AED in adult patients [27] and its efficacy in the initial monotherapy for patients aged 12 years was demonstrated to be comparable to lamotrigine [28], a low usage of levetiracetam was observed in this study. Its late introduction in Korea and restricted indications for pediatric epilepsy might explain this low usage.…”

Efficacy of once-daily extended-release topiramate (USL255): A subgroup analysis based on the level of treatment resistance

“…Annual total costs of drug-resistant epilepsy in the United States approach $4 billion, with average annual health-care costs for a patient with drug-resistant seizures (defined as those on ≥3 AEDs) at $33,613 [10]. Patient benefit in the current analyses was evident not only through traditional measures of seizure frequency but also on the CGI-C, which indicated that clinicians deemed patient status significantly improved with USL255 relative to placebo.…”

“…The specific definitions we chose for patients having "highly drugresistant" seizures (≥2 concurrent AEDs and ≥4 lifetime AEDs) or patients having "less drug-resistant" seizures (1 concurrent AED or b 4 lifetime AEDs) were based on our clinical experience as well as a recent pharmacoeconomic study that classified 'refractory patients' as those on 3 or more AEDs [10]. Our analysis investigates an important group of patients with ILAE-defined "treatment failure."…”

“…Specifically, patients were defined as either having "highly" drug-resistant seizures (≥ 2 concurrent AEDs and ≥ 4 lifetime AEDs) or having "less" drug-resistant seizures (1 concurrent AED or b4 lifetime AEDs) based upon our clinical experience and a more stringent approach relative to a recent analysis defining "refractory" as those patients on 3 or more concomitant AEDs [10]. For each of these two subgroups, median percent reduction in POS frequency, responder rate, CGI-C, and QOLIE-31-P were assessed.…”