Indications of newer and older anti‐epileptic drug use: findings from a southern Italian general practice setting from 2005–2011

Abstract

AIMSThe aim of the study was to analyze the prescribing pattern of both newer and older AEDs. METHODSA population of almost 150 000 individuals registered with 123 general practitioners was included in this study. Patients who received at least one AED prescription over 2005-2011 were identified. The 1 year prevalence and cumulative incidence of AED use, by drug class and individual drug, were calculated over the study period. Potential predictors of starting therapy with newer AEDs were also investigated. RESULTSThe prevalence of use per 1000 inhabitants of older AEDs increased from 10.7 (95% CI10.1, 11.2) in 2005 to 13.0 (95% CI12.4, 13.6) in 2011, while the incidence remained stable. Newer AED incidence decreased from 9.4 (95% CI 8.9, 9.9) in 2005 to 7.0 (95% CI 6.6, 7.5) in 2011, with a peak of 15.5 (95% CI 14.8, 16.1) in 2006. Phenobarbital and valproic acid were the most commonly prescribed AEDs as starting therapy for epilepsy. Gabapentin and pregabalin accounted for most new pain-related prescriptions, while valproic acid and lamotrigine were increasingly used for mood disorders. Female gender (OR 1.36, 95% CI 1.20, 1.53), age ranging between 45-54 years (OR 1.39, 95% CI 1.16, 1.66) and pain as an indication (OR 16.7, 95% CI, 13.1,21.2) were associated with newer AEDs starting therapy. CONCLUSIONSOlder AEDs were mainly used for epileptic and mood disorders, while newer drugs were preferred for neuropathic pain. Gender, age, indication of use and year of starting therapy influenced the choice of AED type. The decrease of newer AED use during 2007 is probably related to the restricted reimbursement criteria for gabapentin and pregabalin.

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents

“…Gabapentin, although classified as an ASD, is most commonly used to treat pain, and valproate may be used to modify behavior [4, 11–13]. Levetiracetam, phenytoin, carbamazepine, lamotrigine, topiramate, primidone, oxcarbazepine, zonisamide, felbamate, tiagabine, ethosuximide, and rufinamide were identified as being primarily used to treat epilepsy.…”

Parental and comorbid epilepsy in persons with bipolar disorder

“…Both BPD and epilepsy have an episodic course, and without treatment, a progression with increased rate of episodes and shortening of symptom-free intervals is commonly seen in both BPD (Angst and Sellaro, 2000) and epilepsy (Kwan and Sander, 2004). Moreover, antiepileptic drugs (AEDs) are also used in the treatment of BPD due to their mood stabilizing properties (Mazza et al, 2007), particularly one of the older AEDs, valproate and a newer AED, lamotrigine (Italiano et al, 2015). Intriguing questions are raised by these similarities including whether BPD and epilepsy have an overlapping etiology and to what degree the association is genetically versus environmentally mediated.…”

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

“…The AEDs included in the analysis were classified as older AEDs (i.e., carbamazepine, ethosuximide, phenobarbital, phenytoin, and valproic acid) and newer AEDs (i.e., gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, topiramate, vigabatrin, zonisamide, lacosamide, and rufinamide) on the basis of market availability before versus after 1991 [13,21].…”

“…Although other options such as surgery and nerve stimulation are available, the use of antiepileptic drugs (AEDs) remains the mainstay of epilepsy treatment. Several epidemiological studies have evaluated AED prescribing patterns in adult and pediatric populations and reported different trends in the use of second-generation AEDs [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Prescription patterns have been evaluated most actively in European countries [3-5, 7-13, 17-19], whereas few studies have reported on AED utilization in large pediatric epilepsy cohorts in Asian countries [15,16].…”