目的:抗癫痫药物(ASM)是育龄妇女最常用的致畸药物之一。关于该人群中不同治疗适应症和新一代ASM的利用模式的数据有限。因此,我们评估了有癫痫和非癫痫适应症(疼痛和精神疾病)的育龄妇女使用ASM的模式.
方法:我们对提交给Optum临床形式学数据库的去识别的管理数据进行了回顾性分析。符合条件的参与者包括12-50岁的女性,她们在2011年至2017年之间填补了ASM。从填写索引处方到研究结束或保险退出之日,对参与者进行随访,以先到者为准。对于整体队列和潜在的治疗适应症,我们评估了ASM填充的类型和频率;单药治疗的参与者比例,综合疗法,或治疗切换;以及连续使用的持续时间。使用从研究开始到研究结束的年度百分比变化来表征趋势。
结果:我们的分析包括465,131名参与者,他们填写了603,916种不同的ASM处方。在基线,大多数参与者患有慢性疼痛(51.0%)和精神疾病(32.7%),癫痫最不常见(0.9%)。最常分配的是地西泮(24.3%),劳拉西泮(20.1%),加巴喷丁(17.4%),氯硝西泮(12.7%),托吡酯(11.3%),和拉莫三嗪(4.6%)。加巴喷丁(年度百分比变化[95%CI]:8.4[7.3-9.4];p<0.001)和左乙拉西坦(3.4[0.7-6.2];p=0.022)趋势呈线性增加趋势,地西泮(-3.5[-2.4至4.5];p<0.001)和氯硝西泮(-3.4[-2.3至4.5];p=0.001)呈下降趋势。丙戊酸盐没有观察到趋势的显着变化(-0.4[-2.7至1.9];p=0.651),而劳拉西泮观察到趋势的非线性变化,托吡酯,拉莫三嗪,还有普瑞巴林.
结论:在整个队列和潜在的治疗适应症中,年龄较大的ASM患者观察到趋势下降。相反,增加的趋势与较新的ASM。考虑到与较新的药物相关的致畸风险,在为育龄妇女开处方ASM时,除了仔细考虑获益与潜在风险外,咨询和教育仍将是关键.
Antiseizure medications (ASMs) are among the most commonly prescribed teratogenic drugs in women of childbearing age. Limited data exist on utilization patterns across different indications for therapy and for the newer-generation ASMs in this population. Thus, we assessed the pattern of ASM use in women of childbearing age with epilepsy and nonepilepsy indications (pain and psychiatric disorders).
We conducted a retrospective analysis of deidentified administrative data submitted to the Optum Clinformatics database. Eligible participants included women aged 12-50 years who filled ASMs between year 2011 and 2017. Participants were followed from date of index prescription filled to
study end or insurance disenrollment, whichever came first. For the overall cohort and potential therapy indications, we assessed the type and frequency of ASMs filled; proportion of participants on monotherapy, polytherapy, or treatment switching; and duration of continuous use. Trends were characterized using annual percent change from
study start to
study end.
Our analysis included 465,131 participants who filled 603,916 distinct ASM prescriptions. At baseline, most of the participants had chronic pain (51.0%) and psychiatric disorders (32.7%), with epilepsy the least common (0.9%). The most frequently dispensed were diazepam (24.3%),
lorazepam (20.1%), gabapentin (17.4%), clonazepam (12.7%), topiramate (11.3%), and lamotrigine (4.6%). Significant linear increase in trends were observed with gabapentin (annual percent change [95% CI]: 8.4 [7.3-9.4]; p < 0.001) and levetiracetam (3.4 [0.7-6.2]; p = 0.022) and decreasing trends for diazepam (-3.5 [-2.4 to 4.5]; p < 0.001) and clonazepam (-3.4 [-2.3 to 4.5]; p = 0.001). No significant change in trend was observed with valproate (-0.4 [-2.7 to 1.9]; p = 0.651), while nonlinear changes in trends were observed with
lorazepam, topiramate, lamotrigine, and pregabalin.
Decreasing trends were observed with older ASMs in the overall cohort and across the potential indications for therapy. Conversely, increasing trends were seen with the newer ASMs. Considering the risk of teratogenicity associated with the newer medications largely unknown, counseling and education in addition to a careful consideration of the benefits vs potential risks should remain pivotal when prescribing ASMs for women of childbearing age.