Real-world analysis of hospitalizations in patients with epilepsy and treated with perampanel

• Type of Material: Article
• Authors: Raymond Faught Jr, Emory University; Edward Faught, Emory University; Xuan Li, Eisai Inc; Jiyoon Choi, Eisai Inc; Manoj Malhotra, Eisai Inc; Russell L Knoth, Eisai Inc
• Language: English
• Date: 2021-08-13
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/epi4.12515
• Title of Journal or Parent Work: EPILEPSIA OPEN
• Volume: 6
• Issue: 4
• Start Page: 645
• End Page: 652
• Grant/Funding Information: Funding for this study was provided by Eisai Inc.
• Keywords: pediatric epilepsy; Life Sciences & Biomedicine; Neurosciences & Neurology; COSTS; Clinical Neurology; Science & Technology; POSITION PAPER; CLASSIFICATION; hospitalizations; antiepileptic drugs; HEALTH-CARE UTILIZATION; healthcare utilization; Neurosciences; ILAE COMMISSION
• Research Categories: Health Sciences, Public Health

Abstract

Objectives: (1) To evaluate risk of hospitalization following initiation of perampanel (pre- and post-analysis) and (2) to compare hospitalization rates following initiation of perampanel vs lacosamide. Methods: Patients were identified from Symphony Health's Patient Integrated Database if they had a prescription for perampanel (July 1, 2014-June 30, 2016). Patients 4-11 years of age with any partial-onset seizure (POS) or ≥12 years of age with any POS or primary generalized tonic-clonic seizure (GTCS) (pre-post); or ≥12 years of age (perampanel vs lacosamide). The first fill of perampanel (“index date”) marked the start of the analysis period. Patients had ≥1 additional fill for perampanel and ≥2 diagnoses for epilepsy or nonfebrile convulsion diagnosis during pre-index (based on ICD-9/ICD-10 codes). Patients were matched using a 1:1 propensity scoring method for the perampanel vs lacosamide analysis. Primary outcome was hospitalization during the one year following medication initiation. Results: Pre- and post-perampanel: N = 1771 (mean age 34 years, 55% female). One-year all-cause hospitalization risk ratio was 0.76 (P <.05) and 36.2% with hospitalization during the pre-period vs 29.5% in the follow-up. One-year epilepsy-related inpatient hospitalization risk ratio was 0.72 (P <.05) and 30.8% with hospitalization during the pre-period vs 23.9% during follow-up. In the perampanel and lacosamide cohorts, N = 1717 per cohort after matching, most baseline demographics were balanced. A higher percentage of subjects were prescribed ≥3 anti-seizure medications for perampanel vs lacosamide (60.5% vs 57.7%, P <.001). The perampanel cohort had a 9.6% reduction in all-cause hospitalizations vs 5.8% for the lacosamide cohort (P <.05). Epilepsy-related hospitalizations decreased from the pre-index rate by 9.9% for perampanel and 8.3% for lacosamide (P <.05). Among those with baseline hospitalizations, perampanel was associated with a 59.9% reduction in all-cause hospitalizations vs 48.6% for lacosamide (P <.05), and for epilepsy-related hospitalizations, a reduction of 65.0% vs 58.9%, respectively (P <.05). Significance: Perampanel was associated with a significant reduction in one-year hospitalization risk.