Abstract Details

Title Effectiveness and Healthcare Utilization with Newly Initiated Antiepileptic Drug Combination Therapy for Partial Onset Seizures According to Mechanisms of Action

Topic Epilepsy

Presentation(s) (-)

Poster/Presentation
Number 009

Objective

Background Assess differences in effectiveness among MOA-based versus non-MOA-based AED combination therapies.

Design/Methods Using administrative claims from the MarketScan Commercial Database with approximately 96 million covered lives, POS patients (ICD-9-CM code 345.4x or 345.5x) newly initiating AED combination therapy between 1/1/2005 and 3/31/2010 with ?6 months pre-index and 12 months post-index eligibility were selected. Index date was the start of the first combination lasting ?90 days. Combination therapies were categorized by each drug's primary MOA: sodium channel blockers (SC), GABA analogs (G), SV2A binding (SV2), and multiple mechanisms (M). Effectiveness was measured by tolerability, inferred from the combination's duration (from index date to the earlier of the combination's end or end of data availability), and by healthcare utilization during the combination's duration. Multivariate analyses evaluated discontinuation risks and healthcare utilization according to AED-MOA combinations.

Results Distribution of the 8,615 selected patients by combination: 3.3% G+G, 7.5% G+SV2, 8.6% G+M, 13.9% SC+SC, 19.0% G+SC, 21.5% SC+M, and 26.3% SC+SV2. Treatment persistence was shortest for G+G (344 days) and longest for SC+SV2 (527 days; p<0.001). Adjusted results using SC+SC as the reference group showed SC+SV2 patients significantly less likely (hazard ratio 0.817, p<0.001) to discontinue therapy; G+G and G+M patients had greater risk of discontinuation (hazard ratios 1.252, 1.172 respectively, both p=0.002). Significantly lower hospitalization risk was found for patients receiving G combinations other than G+G (odds ratio 0.716, p=0.021). Significantly lower ER visit risk was found during SC combinations other than SC+SC (odds ratio 0.853, p=0.025).

Conclusions AED combinations with different MOAs were associated with greater inferred tolerability and lower risks of hospitalization and emergency visits, suggesting a strategy for achieving optimal AED combination therapy outcomes based on different MOAs, rather than same MOAs.

Authors/Disclosures
Zhixiao Wang, PhD (Eisai Inc) PRESENTER	No disclosure on file
Jay M. Margolis	No disclosure on file
	No disclosure on file
	No disclosure on file
Jose E. Cavazos, MD, PhD (U Texas Health San Antonio)	Dr. Cavazos has received stock or an ownership interest from Brain Sentinel . The institution of Dr. Cavazos has received research support from NIH.
Dennis N. Bourdette, MD, FAAN	Dr. Bourdette has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Magellan Health Care. Dr. Bourdette has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Best Doctor's Inc. Dr. Bourdette has stock in Authobahn Therapeutics. Dr. Bourdette has received intellectual property interests from a discovery or technology relating to health care.

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