Authors :
Presenting Author: Danielle A. Becker, MD, MS – The Ohio State University Wexner Medical Center
Sean Stern, MS – SK Life Science, Inc.; Clarence T. Wade, MBA – SK Life Science, Inc.; Vernon F. Schabert, PhD – Epilogix LLC
Rationale:
Cenobamate (XCOPRI®) is an antiseizure medication (ASM) approved in the US as adjunctive or monotherapy treatment for adults with focal seizures. This retrospective observational analysis used healthcare utilization data (epilepsy-related inpatient [IP] stays and emergency room [ER] admissions) from a national claims database to examine the effectiveness of cenobamate monotherapy in patients with epilepsy. Methods:
Patients with an epilepsy diagnosis (ICD-10-CM G40*) taking cenobamate between 5/1/2020 through12/31/2022 were identified from the HealthVerity Marketplace Private Source 20 database. Patients were required to have ≥ 12 months of medical and pharmacy enrollment before their first observed line of therapy with cenobamate. Lines of therapy were defined as the dispensing of an ASM after ≥ 30 days without exposure. Lines of therapy not having overlap with another ASM > 30 days after initiation were considered monotherapy. Outcomes included: rate of epilepsy-related inpatient visit days, rate of epilepsy-related ER visit days, new lines of ASM therapy, new status epilepticus, and epilepsy monitoring unit hours.Results:
A total of 450 patients (60.4% female, mean age 39.6 years) taking cenobamate monotherapy were included. Focal epilepsy was diagnosed in 64.7% (n=291) of patients and 56.7% of patients (n=255) had a history of intractable seizures. Patients starting cenobamate had received an average of 2.46 (range 0-11) previous lines of therapy. During follow-up, 40.0% of patients continued cenobamate monotherapy, 31.1% received add-on therapy, and 28.9% discontinued or switched to another ASM. At least 15 patients started cenobamate as first-line therapy, meaning there was no history of any other ASM prior to cenobamate. An additional 79 patients had no history of other ASMs upon database entry < 180 days prior to cenobamate. Among the 356 patients who switched to cenobamate monotherapy, the most common previous ASMs included levetiracetam (n=53), lamotrigine (n=43), lacosamide (n=35), topiramate (n=28), and brivaracetam (n=22). The median (min, max) duration of follow-up was 334 days (30, 2892 days) during previous ASM lines of therapy and 91 days (30, 943) during cenobamate monotherapy, including titration. During cenobamate monotherapy, the average IP day rate per 100 patients was 0.25 versus 1.48 during previous ASM lines; the average ER day rate per 100 patients was 0.04 for cenobamate versus 0.5 for previous ASM lines. Forty-nine percent of patients taking cenobamate monotherapy had no IP visit, ER stay, or new line of therapy during follow-up. New status epilepticus occurred in 3.1% of patients during cenobamate monotherapy versus 11.9% during previous ASM lines. Patients averaged six hours in epilepsy monitoring units during cenobamate monotherapy versus 20.2 hours during previous therapy lines. Conclusions:
Patients taking cenobamate monotherapy, inclusive of the titration period, experienced decreased healthcare utilization vs previous lines of therapy. These findings support cenobamate as monotherapy and suggest a potential benefit of cenobamate as an earlier line of therapy.Funding:
Funded by SK Life Science, Inc.