Abstracts

Rationale: Over the past 2 decades there has been a faster rate of growth among women veterans than men seeking care at the VA Healthcare System (VAHCS); most of these women are of childbearing potential. Because of concerns about the potential teratogenic effects of prescribing antiseizure medication (ASM), we examined patterns of prescribing for a cohort of women veterans of childbearing age, who were identified as having epilepsy within the VAHCS in FY 2019. Since comorbid health conditions may be associated with prescribing patterns for potentially teratogenic ASMs (PTASM) we examined sociodemographic and health status predictors of receiving PTASMs and other commonly prescribed ASMs.

Methods: The study cohort was derived from a cohort of veterans who received Veterans Health Administration (VHA) care at least three years in DoD and three years in VHA between FY01-FY19. We used ICD9/10 codes and concomitant use of ASMs to identify epilepsy during the study period and examined prescribing patterns for women who were treated for epilepsy in FY10. PTASMs included topiramate (TOP) and valproate (VPA); other commonly prescribed ASMs included gabapentin (GBP), lamotrigine (LTG), and levetiracetam (LEV). Bivariate analyses were used to examine the independent predictors of use for each ASM. Multivariable logistic regression models were used to identify characteristics (age; race/ethnicity; medical, psychiatric, and neurological comorbidities) associated with use of each medication.

Results: We identified 2,843 WVE (ages 17-45) who received ASMs in monotherapy or polytherapy with: GBP (N=829/29%), TOP (N=768/27%), LTG (N=569/20%), LEV (N=447/16%) and VPA (N=230/8%). The majority (62%) received more than one ASM in FY19. Table 2 shows results of logistic regression analyses predicting use of the most commonly used ASMs. ASM polypharmacy was significantly associated with receipt of each medication suggesting that these medications were commonly used in conjunction with other ASMs. Comorbid diagnosis of headache was a significant predictor TOP and VPA. Bipolar diagnosis was associated with prescriptions for LTG and VPA. Schizophrenia diagnosis was associated with VPA, and back/neck pain was significantly associated with GBP. Of note, those receiving LEV and LTG were significantly more likely to receive neurology care previously and in FY19.

Conclusions: With the expansion of care for women in the VAHCS an awareness of the potential teratogenicity of medications for those of childbearing potential is needed. These early findings suggest that in women veterans with epilepsy in the child-bearing years, the use of potentially teratogenic ASM was common. These findings suggest that comorbid conditions, specifically headache and mood disorders are associated with these PTASMs. While we found that prescribing of PTASMs is common, those who received Neurology/epilepsy specialty care were more likely to receive LTG and LEV-ASMs considered safer for women of child-bearing potential.

Funding: Please list any funding that was received in support of this abstract.: CDMRP Epilepsy Research Program W81XWH-18-0247.