Authors :
Presenting Author: Cédric Laloyaux, PhD – UCB, Brussels, Belgium
Tommi Tervonen, PhD – Kielo Research, Zug, Switzerland
Vicente Villanueva, MD, PhD – Universitario y Politecnico La Fe, Valencia, Spain; member of ERN EPICARE
Joseph Sirven, MD – Mayo Clinic, Jacksonville, FL, United States
Alison Kukla, MPH – Partners Against Mortality in Epilepsy, Chicago, IL, United States
Cecilia Jimenez-Moreno, PhD – Kielo Research, York, United Kingdom
Kerrie-Anne Ho, PhD – UCB, Slough, United Kingdom
Rationale:
Rapid and Early Seizure Termination (REST) medications prevent seizures becoming prolonged/progressing in severity, while rescue medications treat seizures that have already prolonged/progressed. Preferences of people with epilepsy/an epilepsy syndrome (PwE) and caregivers (CGs) for attributes of acute (on-demand) seizure medications were explored.
Methods: Survey of PwE aged ≥ 18 yrs who had experienced ≥ 1 prolonged seizure (PS) of ≥ 2 min in past 12 mos and CGs (aged ≥ 18 yrs) of PwE aged ≥ 12 yrs from France/Italy/Poland/Spain/UK/US. A discrete choice experiment (DCE) was used to elicit treatment preferences (analyzed using multinomial logit models) and a willingness to wait exercise for administration of acute seizure medication.
Results: 135 adult PwE, 120 CGs of adults, 119 CGs of adolescents took part (N=374): median age was 45 yrs, 242 (65%) were female. Of 239 CGs, 133 (56%) were parents. Overall, 173 (46%) participants reported generalized or bilateral/tonic-clonic as the most common seizure type; 193 (52%) reported an average of 3–5 seizures/mo and 214 (57%) reported an average duration of 1–4 min for the most common seizure type over past 12 mos. 212 (57%) participants reported using oral acute medication for PS. In DCE, all attributes significantly influenced participants’ treatment preferences (p< 0.05); most important was time to seizure cessation (relative attribute importance [RAI]=32.4%), then administration mode (RAI=26.6%): nasal spray and single-use inhaler were preferred; rectal was least preferred (Fig 1). Participants preferred treating early in the seizure and faster-acting medications (the shortest proposed times to stop the seizure, 1 min and 2 min, were preferred). In subgroup analyses, single-use inhaler was valued more by adult PwE than CGs of adolescents (Fig 2A). Increased chance of stopping the seizure within the provided timeframe was valued more by CGs of adults and CGs of adolescents vs adult PwE (p< 0.05 and p=0.06). Improving the chance of no seizure recurrence for next 12 h was more important to adult PwE vs CGs of adults. European participants preferred oral, buccal, and nasal spray administration more than US participants (Fig 2B). Treatment time window was more important to European participants, who wanted to treat seizures earlier than US participants. Improving the chance of no seizure recurrence for next 12 h was somewhat more important to US vs European participants (p=0.07). Willingness to wait exercise showed that overall, 328 (88%) participants would wait 30 s (the minimum time proposed) to administer acute seizure medication.
Conclusions: Adult PwE and CGs of adults and adolescents highly value fast-acting acute seizure medications (1–2 min, the shortest proposed times to stop the seizure) with non-rectal administration (preference for nasal spray and single-use inhaler), and would administer these early in the seizure (ie, at first symptoms/once seizure has become prolonged). Importance of the treatment attributes suggests an unmet need with current acute treatments for PS.
Funding: UCB-sponsored