Antiepileptic use for epilepsy and nonepilepsy disorders

Leong, Christine; Mamdani, Muhammad; Gomes, Tara; Juurlink, David N.; Macdonald, Erin M.; Yogendran, Marina

doi:10.1212/wnl.0000000000002446

Cited by 31 publications

(35 citation statements)

References 28 publications

(21 reference statements)

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“…The pattern of medications prescribed, particularly the increases in gabapentin and pregabalin, indicates that much of the increase in prescriptions was due to non‐epilepsy indications, particularly pain treatments. This increase in AED prescriptions for non‐epilepsy indications has been observed in Canada, Norway, Italy, Denmark, and the United States …”

Section: Discussionmentioning

confidence: 71%

“…The relatively high levels of prescriptions for gabapentin and pregabalin, usually for neuropathic pain and the recent increases particularly in the United Kingdom and to some extent, Tuscany have been reported earlier in Italy, the United Kingdom, and Norway . Such increases have also occurred in non‐European countries such as Canada and Australia . These increases together with evidence that these AEDs have the strong potential for abuse mean that the utilisation of these products requires future monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Antiepileptic drugs (AEDs) are a diverse class of medicines that are prescribed for an increasing number of indications including epilepsy, bipolar disorder, migraine prophylaxis, and neuropathic pain . AEDs are commonly prescribed to women of childbearing age, and the prevalence of prescribing varies by geographic location .…”

Section: Introductionmentioning

confidence: 99%

“…KEYWORDS antiepileptic medications, epidemiology, health care databases, sodium valproate 1 | INTRODUCTION Antiepileptic drugs (AEDs) are a diverse class of medicines that are prescribed for an increasing number of indications including epilepsy, bipolar disorder, migraine prophylaxis, and neuropathic pain. [1][2][3] AEDs are commonly prescribed to women of childbearing age, [4][5][6][7][8][9] and the prevalence of prescribing varies by geographic location. 9,10 The chronic and serious nature of some of the indications for which they are prescribed means that it is not always possible for women to discontinue their treatment in advance of and during pregnancy.…”

mentioning

confidence: 99%

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Did advice on the prescription of sodium valproate reduce prescriptions to women? An observational study in three European countries between 2007 and 2016

Charlton

Damase‐Michel

Hurault‐Delarue

et al. 2019

Pharmacoepidemiology and Drug

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Objectives In November 2014, the CMDh (a regulatory body representing EU Member States) advised doctors not to prescribe sodium valproate for epilepsy or bipolar disorder in preg nant women, in women who can become pregnant, or in girls unless other treatments are ineffective or not tolerated. This study aimed to determine if this warning led to changes in prescription patterns. Design and setting Cohort of 5.4 million women aged between 10 and 50 years identified in electronic health care data from United Kingdom, France, and Italy (2007–2016). Main outcome measures Anti‐epileptic drug (AED) prescriptions. Results The prevalence of women receiving AED prescriptions in 2016 varied from 12.2 per 1000 to 29 per 1000 in the four regions. The incidence of prescribing any AED (excluding clonazepam, gabapentin, and pregabalin) fell each year on average by 7.5% (95% CI, 7.0%‐8.0%; Emilia Romagna), 9.6% (8.3%‐11.0%; France), 7.1% (6.7%‐7.6%; Tuscany), and 0.4% (0.2%‐1.0%; United Kingdom). The relative odds of prescribing sodium valproate rather than any other AED decreased more after 2014 compared with before the end of 2014 in France (OR = 0.77; 95% CI, 0.60‐0.98), Tuscany (0.81; 0.76‐0.86), Emilia Romagna (0.83; 0.76‐0.90), and the United Kingdom (0.92; 0.80‐1.06; not statistically significant). Conclusions There is evidence that the CMDh warning did lead to changes in prescription patterns of sodium valproate in women of childbearing age. There were considerable differences in prescribing practice amongst regions of Europe.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Did advice on the prescription of sodium valproate reduce prescriptions to women? An observational study in three European countries between 2007 and 2016

Charlton

Damase‐Michel

Hurault‐Delarue

et al. 2019

Pharmacoepidemiology and Drug

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“…When used in patients with epilepsy, gabapentin is often a third‐ or fourth‐line agent. Based on that, a reasonable nested algorithm that applies different algorithms depending on whether the patient is using gabapentin as monotherapy (likely not an epilepsy case) versus polytherapy (a possible epilepsy case) may be valuable …”

Section: Discussionmentioning

confidence: 99%

Accuracy of claims‐based algorithms for epilepsy research: Revealing the unseen performance of claims‐based studies

et al. 2017

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Patterns of anticonvulsant use and adverse drug events in older adults

Moura

Smith

Yan

et al. 2020

Pharmacoepidemiology and Drug

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Purpose To examine indications for, duration of use, and rate of adverse drug events (ADE) attributable to anticonvulsant initiation, as adjudicated by expert review of electronic health records (EHR) of older adults. Methods We identified a cohort of community dwelling Medicare beneficiaries with linked EHR (aged 65+, continuously enrolled with a large health system/until death between 2012 and 2014, n = 20 945) and drew a stratified EHR review sample (n = 1534). An expert reviewed all records to adjudicate anticonvulsant use, years of use, indication for use, and evidence of ADEs attributable to anticonvulsant initiation. After excluding patients with insufficient EHR data (n = 37; 2%), we reconstructed the cohort using inverse probability weights to resemble the original cohort of eligible beneficiaries (n = 20 380). Among incident users of a single anticonvulsant, we estimated the rate of ADEs and described the type and severity of ADEs. Results Overall, 12% (n = 2469) of eligible beneficiaries used at least one anticonvulsant in the 2012 to 2014 period (4% [n = 757] incident users, 8% [n = 1712] prevalent users). Incident users were most frequently prescribed gabapentin (n = 461/757, 61%), benzodiazepines (n = 122/757, 16%), and levetiracetam (n = 74/757, 10%); the most common indication was pain relief (n = 214; 28%) followed by epilepsy (n = 53; 7%). Among incident users, the overall ADE rate was 10/100 person‐years (95% CI 4‐20/100 person‐years), of which 29% (n = 28/97) were life threatening (eg, somnolence). Most ADEs among incident monotherapy users were nervous system related (68%, n = 66/97). Conclusion Many older adult community dwelling traditional Medicare beneficiaries had clinically significant ADEs likely attributable to the initiation of anticonvulsant therapy, which was begun for a range of indications.

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Antiepileptic use for epilepsy and nonepilepsy disorders

Cited by 31 publications

References 28 publications

Did advice on the prescription of sodium valproate reduce prescriptions to women? An observational study in three European countries between 2007 and 2016

Did advice on the prescription of sodium valproate reduce prescriptions to women? An observational study in three European countries between 2007 and 2016

Accuracy of claims‐based algorithms for epilepsy research: Revealing the unseen performance of claims‐based studies

Patterns of anticonvulsant use and adverse drug events in older adults

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