This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session
Rationale: One of the primary goals of Epilepsy Centers of Excellence (ECoE) in the Veterans Health Administration (VHA) is to identify patterns of prescribed antiseizure medications (ASMs) for providing guidance for appropriate treatment. The main objectives of this study were to identify prescribing trends of ASMs in the VHA for Veterans with epilepsy during Fiscal Year 2018 (FY18) and to compare with FY14 data. Methods: Veterans with epilepsy were defined as those prescribed an ASM for at least 30 days during FY18, active seizure status on the problem list, and a documented seizure diagnosis between FY16-FY18. Demographic information collected included age, gender, ethnicity, race, rurality and OEF/OIF/OND (Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn) status. Age was categorized into those less than 45 years of age, those 65 years of age or older (geriatric patients), and those in between. ASMs were divided between old ASMs (first generation) versus new ASMs. For statistical significance between proportions the error rate (alpha=0.05) was adjusted using Bonferroni correction. Results: Overall, 55,781 Veterans with epilepsy were included in the FY18 study. The majority, 91.7%, were males. Race: White comprised 70.9% and Black 20.3%, Ethnicity: 91.2% were identified as Non-Hispanic and 5.2% were Hispanic. There were 34.7% Veterans from rural areas. OEF/OIF/OND status was noted in 6.4% of the population. The most commonly prescribed ASMs were levetiracetam (47.7%), phenytoin (18.2%) and lamotrigine (15.5%). The use of phenytoin was highest (23.4%) among geriatric patients. Statistically significant differences were identified between genders for topiramate (26.0% females versus 7.8% males), phenytoin (6.7% females versus 19.3% males), levetiracetam (39.2% females versus 48.5% males) and lamotrigine (24.2% females versus 14.7% males). Overall, 56.9% were prescribed only new ASMs, and this was more common in females (70.2% females versus males 55.7%). Comparison with a similar study performed for FY14 patients (T. Tran et al., AES 2016) revealed statistically significant differences in the use of levetiracetam (9.0% increase) and phenytoin (10.2% decrease). Monotherapy significantly increased by 10.4% and the use of new ASMs increased by 13.0% over time. Conclusions: Comparison between FY14 and FY18 data suggests a transition towards prescribing new ASMs and monotherapy treatment. The use of phenytoin across all age groups significantly decreased over time. Female Veterans were more likely to be prescribed new ASMs, particularly levetiracetam, lamotrigine and topiramate, reflecting gender awareness in prescribing habits. As topiramate is linked to teratogenicity, providers should communicate this risk with all potential patients of child-bearing age.
Reference: T. Tran et.al (2016) Epilepsy Treatment Prescribing Trends for Veterans. AES 2016 Annual Meeting Abstract Database. AESnet.org Funding: Please list any funding that was received in support of this abstract.: No funding was provided.
