Amanda Gusovsky1, Chun Chieh Lin3, Kevin Kerber3, Seuli Brill2, James Burke3, Sarita Maturu3
1The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), 2Department of Internal Medicine, The Ohio State University College of Medicine, 3Department of Neurology, Ohio State Wexner Medical Center
Objective:
To observe adherence to anti-seizure medications (ASMs) in preconception and early pregnancy stages.
Background:
Seizures in pregnant women with epilepsy (WWE) are controlled using ASMs. Optimal care includes avoiding ASMs with increased teratogenic effects (i.e., valproate and topiramate). Little is known about adherence to ASMs in preconception and early pregnancy stages.
Design/Methods:
This retrospective cohort study using Merative™ MarketScan® claims databases included female patients diagnosed with epilepsy with an ASM in the year following incident diagnosis, and with pregnancy any time after incident diagnosis. Patients with pregnancy during the washout period (1 year pre- to 6 months post-incident diagnosis) and aged outside 13-50 at pregnancy were excluded. Quarterly ASM adherence (mean proportion of days covered (PDC)) 1 pre- (baseline) to 6 quarters post-start of pregnancy, and PDC change from baseline were observed.
Results:
A total of 2,179 female patients met study criteria. Mean age was 30 years (SD=6). The most common ASMs were: levetiracetam (35%), lamotrigine (31%), topiramate (10%), lacosamide (4%), valproate (4%), and carbamazepine (3%); and 29% had no ASM fills. Overall, PDC was 64% (SD=27) pre-pregnancy, dropped to 57% (SD=34) in the first trimester, and gradually increased back to 64% (SD=28) in the sixth quarter. Adherence varied for some medications. From 1 quarter prior to the start of pregnancy, adherence (mean (SD)) to lacosamide (68% (25) to 64% (25)) and valproate (63% (30) to 55% (31)) dropped, while others changed minimally. From start of pregnancy to first trimester, adherence to all ASMs dropped (64% (27) to 57% (34)) except for valproate (55% (31) to 57% (35)) and topiramate (58% (27) to 59% (33)).
Conclusions:
Adherence to ASMs trended downward in pre- and/or early pregnancy with varying patterns for individual ASMs. Factors influencing ASM adherence or switching during pregnancy may inform perinatal interventions for patients with epilepsy.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.