Authors :
Presenting Author: R. Edward Faught, MD – Emory University School of Medicine
Wesley T. Kerr, MD, PhD – University of Pittsburgh; Emily Klatte, MD – OhioHealth; Sean Stern, MS – SK Life Science, Inc.; Clarence T. Wade, MBA – SK Life Science, Inc.
Rationale:
Medical comorbidities are common in people with epilepsy and can impact their medical care and quality of life and contribute to increased health care costs. This retrospective, observational analysis evaluated the incidence of comorbidities in adults with epilepsy taking antiseizure medication (ASM) in a nationally representative healthcare claims database.Methods:
Adults (≥18 years) with an epilepsy diagnosis (ICD-10-CM G40*) taking ≥1 ASM between January 1, 2015 and December 31, 2021 were identified from HealthVerity Marketplace Private Source 20, a healthcare claims database that includes more than 150 US commercial, Medicare, and Medicaid payers. Patients were required to have 12 months of medical and pharmacy enrollment before their first ASM. For each patient, we identified when they started their first ASM, as defined by the first dispense of an ASM for ≥30 days. We grouped patients into controlled or uncontrolled epilepsy. Uncontrolled epilepsy was defined by the occurrence of ≥1 of the following: seizure-related inpatient visit, seizure-related emergency room visit, or new ASM line of therapy initiation during the patient’s follow-up. In patients with uncontrolled vs controlled epilepsy, we compared the relative risk of a patient developing a new (incident) comorbidity after initiating their first ASM as identified in the data. Comorbidities were selected following a targeted literature search for factors impacting epilepsy management in US and International guidelines. Patients must have been naïve to the comorbidity at baseline. Results:
There were 196,163 unique patients with epilepsy whose first ASM start date was identified (mean age 43.6 years; 57.2% female). Of the patients included, 24% (47,195) had controlled epilepsy and 76% (148,968) had uncontrolled epilepsy during follow-up. The median duration of follow-up after first ASM was 53 months (interquartile range 23-76 months). Following initiation of the first ASM therapy, there was an increased incidence of several comorbidities in those with uncontrolled epilepsy compared to those with controlled epilepsy (Table 1). Among some of the most common comorbidities in patients with epilepsy, patients with uncontrolled versus controlled epilepsy in this analysis were 61% more likely to receive a new diagnosis of mood disorder, 79% more likely to receive a new diagnosis of stroke, and 34% more likely to receive a new diagnosis of hypertension.Conclusions:
Patients with uncontrolled epilepsy had a higher incidence of new comorbidities than patients with controlled epilepsy after starting the first ASM. This suggests that there may be a relationship between seizure control and developing or identifying comorbidities. This work builds upon prior literature demonstrating the importance of addressing comorbidities of epilepsy, in addition to addressing the seizures themselves. Further work is needed to examine the relationships between seizure control, medication use, and new-onset comorbidities in patients with epilepsy. Funding:
Funded by SK Life Science, Inc.