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Abstract Details

Adherence to Epilepsy Medications Around Pregnancy
Epilepsy/Clinical Neurophysiology (EEG)
P1 - Poster Session 1 (11:45 AM-12:45 PM)
9-004
To observe adherence to anti-seizure medications (ASMs) in preconception and early pregnancy stages.
Seizures in pregnant women with epilepsy (WWE) are controlled using ASMs. Optimal care includes avoiding ASMs with increased teratogenic effects (i.e., valproate and topiramate). Little is known about adherence to ASMs in preconception and early pregnancy stages.
This retrospective cohort study using Merative™ MarketScan® claims databases included female patients diagnosed with epilepsy with an ASM in the year following incident diagnosis, and with pregnancy any time after incident diagnosis. Patients with pregnancy during the washout period (1 year pre- to 6 months post-incident diagnosis) and aged outside 13-50 at pregnancy were excluded. Quarterly ASM adherence (mean proportion of days covered (PDC)) 1 pre- (baseline) to 6 quarters post-start of pregnancy, and PDC change from baseline were observed.
A total of 2,179 female patients met study criteria. Mean age was 30 years (SD=6). The most common ASMs were: levetiracetam (35%), lamotrigine (31%), topiramate (10%), lacosamide (4%), valproate (4%), and carbamazepine (3%); and 29% had no ASM fills. Overall, PDC was 64% (SD=27) pre-pregnancy, dropped to 57% (SD=34) in the first trimester, and gradually increased back to 64% (SD=28) in the sixth quarter. Adherence varied for some medications. From 1 quarter prior to the start of pregnancy, adherence (mean (SD)) to lacosamide (68% (25) to 64% (25)) and valproate (63% (30) to 55% (31)) dropped, while others changed minimally. From start of pregnancy to first trimester, adherence to all ASMs dropped (64% (27) to 57% (34)) except for valproate (55% (31) to 57% (35)) and topiramate (58% (27) to 59% (33)).

Adherence to ASMs trended downward in pre- and/or early pregnancy with varying patterns for individual ASMs. Factors influencing ASM adherence or switching during pregnancy may inform perinatal interventions for patients with epilepsy.
Authors/Disclosures
Amanda V. Gusovsky Chevalier, PhD
PRESENTER 		Dr. Gusovsky Chevalier has nothing to disclose.
Chun Chieh Lin, PhD (The Ohio state University) The institution of Dr. Lin has received research support from AAN. The institution of Dr. Lin has received research support from Genentech Inc. The institution of Dr. Lin has received research support from NIH.
Kevin A. Kerber, MD (Ohio State University Department of Neurology) Dr. Kerber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 好色先生. The institution of Dr. Kerber has received research support from National Institutes of Health. The institution of Dr. Kerber has received research support from Genentech, Inc . Dr. Kerber has received publishing royalties from a publication relating to health care.
Seuli Brill, MD The institution of Dr. Brill has received research support from NIH. The institution of Dr. Brill has received research support from HRSA. The institution of Dr. Brill has received research support from PCORI.
James F. Burke, MD (Ohio State Wexner Medical Center) Dr. Burke has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association/Circulation: Cardiovascular quality and outcomes. The institution of Dr. Burke has received research support from Genentech Foundation. The institution of Dr. Burke has received research support from NIH.
Sarita W. Maturu, MD (Wexner Medical Center) Dr. Maturu has nothing to disclose.