Outcomes associated with switching from monotherapy to adjunctive therapy for patients with partial onset seizures

Abstract

Background: Some patients with partial onset seizures are drug-resistant and may benefit from adjunctive therapy. This study evaluated monotherapy/sequential monotherapy versus adjunctive therapy on use/costs. Methods: Retrospective analysis using commercial/Medicare database (1 January 2007 to 31 December 2009). Patients with ≥2 diagnoses for partial onset seizures who received ≥2 prescriptions of the same antiepileptic drug were included. Outcomes assessed in the 12-month follow-up period were hospitalizations, ER visits, outpatient visits and prescription costs for patients who received monotherapy but switched to adjunctive. Results: 1353 patients met criteria. After patients transitioned to adjunctive therapy, the average monthly percentage of patients with a hospitalization decreased from 5.3 to 3.0% (p < 0.0001). Similar results occurred with epilepsy-related hospitalizations (4.0 vs 1.7%, p < 0.0001). Adjusted costs decreased significantly (US$4205 vs 2944/month, p < 0.0001). Adjusted epilepsy-related costs decreased from US$1601 to 909/month (p < 0.0001). Conclusion: Adjunctive therapy in potentially drug-resistant patients with partial onset seizures can lead to reduced healthcare use and costs.

Keywords:

• adjunctive therapy
• anti-epileptic drugs
• epilepsy
• partial onset seizures
• sequential monotherapy

Financial & competing interests disclosure

This work was funded by Eisai Inc. Z Wang, X Li and A Powers are all employees of Eisai Inc. Meg Franklin of Franklin Pharmaceutical Consulting LLC provided assistance with manuscript preparation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Partial onset seizures account for approximately 60% of patients with epilepsy.

• Even when medications are taken properly, up to 30% of patients with partial onset seizures still suffer from inadequate seizure control.

• Adjunctive therapy is a viable option for patients who do not respond to monotherapy, but the clinical and economic evidence to support the use of adjunctive therapy is still limited.

• Results from this study indicate that patients who were initiated on monotherapy and transitioned to adjunctive therapy incurred lower resource use and costs.

• Transitioning from monotherapy to adjunctive therapy in potentially drug-resistant patients with partial onset seizures can lead to reduced overall and epilepsy-related healthcare use and costs.

Notes