Abstract Details

Title Patterns of discontinuation of Epilepsy Specific Anti-Seizure Medications in Medicare Beneficiaries

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 9-011

Objective We analyzed patterns of discontinuation of epilepsy specific anti-seizure medications (ESMs) in a national sample of older adults after acute ischemic stroke (AIS) discharge.

Background The lack of guidelines for managing ESM use in post-stroke patients poses a challenge for providers and may contribute to differences in drug selection and treatment duration.

Design/Methods We retrospectively analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for first AIS between 2009-2021, who were discharged and initiated ESM treatment within 30 days. We excluded patients without continuous Part D Medicare coverage and those prescribed ESMs before discharge. Death and non-persistence (no refill for over 90 days) were censoring factors. We used an adjusted proportion of days covered (PDC) measure, accounting for prescription overlap, hospital readmissions, and non-persistency to analyze medication discontinuation patterns during the first year after discharge among ESMs initiators (the 3 most commonly prescribed). We applied cumulative PDCs and trajectory clustering to characterize adherence behavior.

Results

In this cohort of 1,961 ESM initiators, 1,708 patients met the inclusion criteria, including a total of 1,607 for Levetiracetam, 64 for Lamotrigine, and 50 for Carbamazepine. Over half patients had cumulative PDCs below 0.8 in the first year: Levetiracetam (63%), Lamotrigine (59%), and Carbamazepine (64%). With 0.8 as a threshold, 43% discontinued Levetiracetam within two months, and 26% for Lamotrigine and 53% for Carbamazepine (p=0.03). Longitudinal clustering model identified four distinct medication discontinuation patterns, with the following proportions for the three medications: fast discontinuation [<1month] (34%, 34% and 42%), early discontinuation [2-6 months] (17%, 17%, 10%), late discontinuation [7-12 months] (13%, 13%, 12%), and long-term adherent [12 months or more] (36%, 36%, 36%). The differences across the medications were substantial (p<0.01).

Conclusions

Medicare beneficiaries who survive an acute ischemic stroke and are discharged home exhibit varying patterns in drug choice and treatment duration trajectories.

Authors/Disclosures
Rafaella Cazé de Medeiros, MD PRESENTER	Miss Cazé de Medeiros has nothing to disclose.
Shuo M. Sun, PhD (Harvard T.H. Chan School of Public Health)	Dr. Sun has nothing to disclose.
Julianne Brooks	Julianne Brooks has nothing to disclose.
Madhav Sankaranarayanan	Mr. Sankaranarayanan has nothing to disclose.
Sebastien Haneuse (Harvard T.H. Chan School of Public Health)	Sebastien Haneuse has received personal compensation for serving as an employee of Harvard University. Sebastien Haneuse has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association.
Lidia Maria V. Moura, MD, PhD, MPH, FAAN (Massachusetts General Hospital)	Dr. Moura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Moura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. The institution of Dr. Moura has received research support from Centers for Diseases Control and Prevention (CDC SIP20-007) . The institution of Dr. Moura has received research support from Epilepsy Foundation of America . The institution of Dr. Moura has received research support from NIH - NIA and NINDS. Dr. Moura has received personal compensation in the range of $50,000-$99,999 for serving as a Expert Advisor with Epilepsy Foundation .

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