Objective:

To evaluate incident comorbidities in adults with epilepsy taking antiseizure medication (ASM).

Background:

Medical comorbidities are common in people with epilepsy and can impact their medical care and quality of life.

Design/Methods:

Adults (≥18 years) with epilepsy (ICD-10-CM G40*) taking ≥1 ASM between 1/1/2015-12/31/2021 were identified from the HealthVerity Marketplace Private Source 20 claims database. Patients had to have 360 days of pharmacy/medical enrollment before and after initiating ASM line of therapy (LOT, defined as dispensing of an ASM for ≥30 days). Uncontrolled epilepsy was defined as ≥1 of the following: seizure-related inpatient or emergency room visit, or new ASM LOT initiation during follow-up. Uncontrolled patients were matched with controlled patients using propensity matching. In each cohort, we compared time-to-first occurrence of new comorbidities after initiating first or third observed LOT up to 720 days after an uncontrolled event. Comorbidities assessed were atrial fibrillation, diabetes, high cholesterol, hypertension, obesity, alcohol/substance abuse disorder, mood disorder, nonepileptic seizures, psychiatric disorders, sleep disorders, brain trauma, dementia/Alzheimer's disease, migraine, status epilepticus, and stroke.

Results:

78,714 unique patients received first LOT; 64,031 received third LOT. 57% and 56% of first and third LOT patients, respectively, had uncontrolled epilepsy within the first 360 days after initiating ASM. The incidence of all assessed comorbidities except diabetes, high cholesterol, hypertension, and obesity were increased in the uncontrolled vs controlled cohorts following first LOT (hazard ratios ranging from 1.02 for sleep disorders to 2.92 for non-epileptic seizures). In most cases, hazard ratios increased following third compared to first LOT, and all comorbidities except high cholesterol were increased in uncontrolled vs controlled cohorts following third LOT.

Conclusions:

Patients with uncontrolled epilepsy had a higher incidence of new comorbidities than patients with controlled epilepsy after starting their first and third observed ASM. Further work is needed to examine the nature of these relationships.