目的:很少有研究评估医生选择抗癫痫药物(ASM)来治疗新诊断的癫痫患者。这项研究的目的是分析ASM的选择及其按年龄的使用,性别,精神病合并症,以及在使用单一疗法开始癫痫治疗的患者中与其他药物(抗抑郁药和避孕药)同时治疗。
方法:本研究包括瑞典患者登记册(SPR)中2010-2022年期间住院诊断为癫痫的患者(任何年龄),在首次分发任何ASM之前(如瑞典处方药物登记册中所述,SPDR)2010-2022年期间。在SPR中,2000-2009年期间使用回顾性信息确定了事件患者。主要结果是首先按年龄分配ASM,性别,合并症,以及与抗抑郁药或避孕药(SPDR)的混淆。次要结果是通过生存分析评估的ASM转换或终止时间。
结果:包括67,984名患者(平均年龄46岁;46%为女性),66,441开始使用单一疗法进行ASM治疗。使用单一疗法开始治疗的相对风险(RR)在年龄组之间没有差异,性别,或同时使用抗抑郁药治疗的患者,避孕药,或精神疾病(RR和95%CI包括1.0)。使用左乙拉西坦开始治疗的份额从2010年的10%增加到2022年的55%;丙戊酸:10%-5%。使用5个最常见的ASM中的1个开始治疗的可能性在所有比较组间不同(0.3结论:左乙拉西坦和拉莫三嗪是最常见的初始ASM,此外,在有合并症或并发症的患者中,使用这些ASM复杂化,强调需要改进处方者关于个体患者特征的ASM选择的教育。在SPDR中未捕获在医院中使用ASM。
OBJECTIVE: Few studies evaluate physicians\' choice of antiseizure medication (ASM) to treat patients with newly diagnosed epilepsy. The objective of this
study was to analyze the choice of ASM and its use by age, sex, psychiatric comorbidities, and concurrent treatment with other drugs (antidepressant medications and contraceptives) in patients who initiated epilepsy treatment using monotherapy.
METHODS: Included in this
study were persons (any age) with an incident hospital diagnosis of epilepsy during 2010-2022 in the Swedish Patient Register (SPR), preceding a first dispensing of any ASM (as reported in the Swedish Prescribed Drug Register, SPDR) for the period 2010-2022. Incident patients were identified using retrospective information during 2000-2009 in the SPR. Primary outcome was first dispensed ASM by age, sex, comorbidity, and comedication with antidepressants or contraceptives (SPDR). Secondary outcomes were time to ASM switch or termination assessed by survival analyses.
RESULTS: Of 67,984 patients included (mean age 46; 46% female), 66,441 initiated ASM treatment using monotherapy. Relative risk (RR) for initiating treatment using monotherapy did not differ between age groups, sex, or patients with concurrent treatment with antidepressants, contraceptives, or psychiatric illness (RR and 95% CI did include 1.0). The share initiating treatment using levetiracetam increased from 10% in 2010 to 55% in 2022; valproic acid: 10%-5%. The likelihood of initiating treatment using 1 of the 5 most frequent ASMs differed between all compared groups (0.3 < RR < 1; 95% CI < 1; 1 < RR < 15; 1 <95% CI). Seven percent of female patients of childbearing age initiated treatment with valproic acid, levetiracetam was the most frequent initial ASM in patients with psychiatric comorbidity (40.2%), and lamotrigine the most prescribed initial ASM to women on contraceptives (50.4%). Highest likelihoods of treatment termination were found among children (1.72 < RR < 3.07; 1 <95% CI) and among patients with psychiatric comorbidity (initiated on carbamazepine, RR 1.38; 1 <95% CI or lamotrigine, RR 1.31; 1 <95% CI). Thirty-one percent to 47% of patients switched from an initial monotherapy to a new monotherapy within 5 years. Twenty percent to 42% terminated ASM treatment within 5 years.
CONCLUSIONS: Levetiracetam and lamotrigine were the most frequently dispensed initial ASMs, also among patients with comorbidities or comedications complicating the use of these ASMs, highlighting the need for improved education of prescribers concerning ASM selection in relation to individual patient characteristics. Use of ASMs in hospital is not captured in the SPDR.