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Antiepileptic drug treatment patterns in women of childbearing age with epilepsy

JAMA Jul 14, 2019

Kim H, et al. - Via performing a cohort study that included 46,767 women of childbearing age with epilepsy recruited from a nationwide commercial database and supplemental Medicare as well as Medicaid insurance claims data January 1, 2017, to February 22, 2018, experts analyzed antiepileptic drug (AED) treatment patterns. They also identified variations in the use of valproate sodium and topiramate by comorbidities. Among 3,219 women in the incident epilepsy group who received AEDs for ≥ 90 days, 3,173 received monotherapy as a first-line treatment; among 28,239 treated prevalent cases, 18,987 received monotherapy. During ≥ 180 days of follow-up post-diagnosis, in 3,544 incident cases and 9,480 prevalent cases, AED treatment was not recorded. For generalized epilepsy and for focal epilepsy, valproate and phenytoin and oxcarbazepine were often used, respectively. Leading AEDs prescribed for both focal and generalized epilepsy were levetiracetam, lamotrigine, and topiramate. For women with comorbid headache or migraine, mood disorder, and anxiety and dissociative disorders, valproate was more commonly given whereas topiramate was more likely prescribed to those who had comorbid headaches or migraines. Hence, regardless of known teratogenicity risks, many women were observed to be treated with valproate and topiramate. Moreover, despite their teratogenicity risks, comorbidities could influence selecting certain AEDs.

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