Abstracts

Rationale: There are numerous medications available now available for the management of epilepsy. Many are being used as adjunctive therapies for patients with medically refractory epilepsy. Understanding how these medications are being utilized with other concurrent AEDs is valuable.  Methods: 5471 consecutive patients admitted to Pediatric and Adult Epilepsy Monitoring Units between 1/10/2010 and 6/24/2019 were analyzed regarding what AEDs they were on at the time of admission. Patients who were on newly FDA approved medications during this time (perampanel (2012), esclicarbazepine (2013), clobazam (2011), and/or brivaracetam (2016)) were included in the study. Demographic data, as well as the number and names of concurrent AEDs were analyzed.   Results: Over this time period 228 were identified as taking one of more of these newly approved AEDs. Clobazam (206 patients) was the most commonly used followed by perampanel (29), esclicarbazepine (26) and brivaracetam (18) (Table 1). Over half of the patients prescribed clobazam were <18 years old (103 patients) while the other medications were either entirely or largely prescribed to adult patients.  Esclicarbazepine was had the lowest average of concurrent AEDs (1.4), followed by clobazam (1.9), brivaracetam (1.9) and perampanel (2.2).  The most common concurrent AED used for all patients on newly approved AEDs was levetiracetam (120), lamotrigine (74), lacoasmide (52) and valproate (46) (Figure 1). Valproate was most likely to be used with clobazam (41).   Conclusions: Newly approved AEDs are commonly used as adjunctive therapies, despite some being FDA approved as monotherapy. The most commonly concurrent AEDs are medications which longstanding proven efficacy and low side effect and efficacy profiles (levetiracetam, lamotrigine, and lacosamide). Clobazam was by far most likely to be prescribed than other new AEDs over this time period. Additionally, 8% of patients of patients who are on perampanel, eslibarbazepine or brivaracetam were also on clobazam. This available data suggests that clobazam is more likely to be considered as an adjunctive therapy for epilepsy over more recently FDA approved AEDs. The reasons for this are likely multifactorial, but likely include tolerability and its broad efficacy for multiple epilepsy types, among others.   As more AEDs become FDA approved for epilepsy, it will be valuable to see if prescribing trends of the AEDs approved between 2010 and 2016 are altered. It would be valuable in future studies to see if these prescribing trends can be reaffirmed in larger patient cohorts.  Funding: No funding