Objective:

To evaluate the comparative effect of initiating cenobamate vs selected antiseizure medications (ASMs, brivaracetam, clobazam, eslicarbazepine, lacosamide, or perampanel) on epilepsy-related and all-cause inpatient (IP) and emergency room (ER) utilization rates.

Background:

Cenobamate is an ASM approved for adults in the US that has demonstrated efficacy across focal seizure subtypes.

Design/Methods:

A retrospective observational study using de-identified electronic health records from the Truveta database identified adults (≥18 years) with an epilepsy diagnosis who initiated cenobamate or another selected ASM between 1/1/202012/52024. The other selected ASMs were chosen based on similar patterns of use primarily in medication-resistant epilepsy. Patients were included if they reached a minimum effective dose (100 mg for cenobamate, per US label for selected ASMs) and remained on treatment for ≥90 days after initiation. Patients with an epilepsy-related ER visit or IP admission in the previous 180 days were excluded. The endpoints were the annual rate of epilepsy-related and all-cause ER visits and IP admissions evaluated during the 90-day period after initiation and subsequent 360-day period.

Results:

The study sample contained 1805 patients (mean age 41.4 years, 51.2% female), including 361 patients who initiated cenobamate and 1444 propensity-matched patients who initiated other selected ASMs. In the epilepsy-related analysis, treatment with cenobamate was associated with a 48% reduction (95% CI: 29%-61%) vs the selected ASM group in annual IP admissions, and a 35% reduction (95% CI: 8%-54%) in annual ER visits. In the all-cause analysis, treatment with cenobamate was associated with a 37% reduction (95% CI: 25%-48%) vs the select ASM group in annual IP admissions, and a 34% reduction (95% CI: 23%-43%) in annual ER visits.

Conclusions:

Initiating cenobamate was associated with a significant reduction in both epilepsy-related and all-cause IP admissions and ER visits compared to propensity-matched patients who similarly could have initiated cenobamate but instead initiated other ASMs.