Valproatverordnungen bei Mädchen und Frauen im gebärfähigen Alter in Deutschland

Wentzell, Nadine; Haug, Ulrike; Schink, Tania; Engel, Susanne; Liebentraut, Judith; Linder, Roland; Onken, Marlies; Schaefer, Christof; Dathe, Katarina

doi:10.1007/s00103-018-2768-1

Cited by 14 publications

(4 citation statements)

References 21 publications

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“…To the best of our knowledge, there are no studies for Germany analyzing OAED prevalence until 2020. A former study from Wentzell et al 8 based on data of several German health insurance funds reported a similar decrease in valproate prescribing in women of childbearing age for 2004–2016. Jacob et al 9 studied patients treated in Germany by neurologists and general practitioners between 2009 and 2017.…”

Section: Discussionmentioning

confidence: 76%

Prescribing of valproate and oral antiepileptics for women of childbearing age and during pregnancy in Germany between 2010 and 2020

Scholz

Köster

Meyer

et al. 2023

Pharmacoepidemiology and Drug

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PurposeTo examine prescriptions of valproate and oral antiepileptic drugs (OAED) in Germany irrespective of the indication in women in general and particularly in women of childbearing age (13–49 years) and during pregnancy between 2010 and 2020, that is, before, during and after the implementation of the EU risk minimization measures (RMMs).MethodsAnalysis of claims data. Study population: all women continuously insured with the AOK health insurance fund in the respective observation year (2010–2020) and the previous year. OAED were identified by ATC code N03. Period of pregnancy was calculated based on birth information in claims data. Main outcomes measures: (i) prevalent use of valproate/OAED: number of women with at least one prescription of valproate/OAED per year divided by all women of the study population (rate per 1000 women); (ii) percentage of OAED recipients with at least one valproate prescription during pregnancy (13–49 years) in the respective observation year.ResultsPrevalence rate/1000 women for valproate use decreased by −31.33% across all age groups (2010–2014: −7.48%; 2014–2018: −16.47%; 2018–2020: −11,17%) with a strong reduction in women 13–49 years between 2014 and 2018 (−28.74%). The rate for OAED across all age groups rose from 33.43/1000 women in 2010 to 41.03/1000 (+22,73%). Valproate use during pregnancy of women with OAED declined from 1.29% in 2010 to 0.59% in 2020 (−54,26%) (2010–2014: −5.14%; 2014–2018: −42.31%; 2018–2020: −16.69%).ConclusionEven if, due to the descriptive nature of the study, no causal relationship can be postulated between the RMMs and the strong decrease in valproate prescriptions, our results are compatible with the hypothesis that the measures have improved drug therapy safety.

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Section: Discussionmentioning

confidence: 76%

Prescribing of valproate and oral antiepileptics for women of childbearing age and during pregnancy in Germany between 2010 and 2020

Scholz

Köster

Meyer

et al. 2023

Pharmacoepidemiology and Drug

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“…In that analysis, we observed an overall declining trend in valproate dispensations since 2004 and particularly since 2014. This trend was most pronounced in women between 21 and 35 years of age and in girls and women with epilepsy (Wentzell et al, 2018a).…”

Section: Discussionmentioning

confidence: 91%

“…To assess whether these recommendations changed prescribing patterns, various different approaches are needed. In cross-sectional analyses, we found that the overall age standardized rate of women of childbearing age with at least one dispensation of valproate has declined by 28% between 2004 and 2016, with the largest decline in epilepsy patients (Wentzell et al, 2018a). In an ongoing study we investigate trends in the proportion of pregnant women with epilepsy exposed to valproate during the critical time window (study is being prepared for publication).…”

Section: Introductionmentioning

confidence: 99%

Characterization of pregnancies among women with epilepsy using valproate before or during pregnancy – A longitudinal claims data analysis from Germany

Wentzell

Haug

2022

Epilepsy Research

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“…Other studies in Europe reported a decrease in valproate prescription in women of childbearing age. For example, in Germany in 2017 a card was released to GPs to inform patients about valproate, and a study reported decreasing trends in prescription of valproate, especially for epilepsy, in women of childbearing age (27). Similarly, an Irish study described similar trends in valproate prescription among women for epilepsy.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study

Gaudio

Konstantara

Joy

et al. 2020

Preprint

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Background: Valproate is teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore GPs’ prescription patterns over time, describe trends, and explore inter-practice variation within primary care. Methods: We identified women of childbearing age (12-46 years old) in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network. We performed repeated cross-sectional analyses from 2004 to 2018 to determine rates of prescription and a retrospective cohort estimated the prevalence of use of valproate during pregnancy. Results: In 2004, 0.31% (95% Confidence Interval (95%CI):0.18 to 0.44%) women were prescribed valproate, decreasing to 0.16% (95%CI:0.07 to 0.24%) by 2018. Among women with epilepsy, the rate fell from 15.2% (95%CI:14.4 to 16.0%) to 8.8 % (95% CI:8.2 to 9.7%) over the same period. In 2018, almost two thirds (62.2%) of women who were prescribed valproate had epilepsy only, whereas bipolar disorder and migraine accounted for 15.8% and 7.4% respectively. Contraceptive prescriptions did not increase over time, and only in 2018 was there greater odds of being prescribed contraception (OR 1.41, 95%CI:1.08 to 1.45). Just under a fifth (19.7%) of women were prescribed valproate during their pregnancy; two out of three of these pregnancies were preceded by folic acid prescription (5 mg). While some practices reduced their rate of valproate prescription, others did not.Conclusions: Regulatory guidelines have changed GPs' prescription patterns in women of childbearing potential for valproate but not for contraception. Further research is needed to identify the barriers of GPs and women of childbearing potential to undertaking contraception.

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Valproatverordnungen bei Mädchen und Frauen im gebärfähigen Alter in Deutschland

Abstract: Based on German claims data, a decline of valproate dispensations was shown for epilepsy patients of childbearing age, while the proportion in other indications has hardly changed since 2004.

Cited by 14 publications

References 21 publications

Prescribing of valproate and oral antiepileptics for women of childbearing age and during pregnancy in Germany between 2010 and 2020

Prescribing of valproate and oral antiepileptics for women of childbearing age and during pregnancy in Germany between 2010 and 2020

Characterization of pregnancies among women with epilepsy using valproate before or during pregnancy – A longitudinal claims data analysis from Germany

Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study

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