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Author Notes:

Address for Correspondence: Edward Faught, M.D., Department of Neurology, Emory University, Brain Health Center 292, 12 Executive Park Drive NE, Atlanta, GA 30306, Telephone: 404-550-2634, rfaught@emory.edu

The authors are grateful to Aquila Brown-Galvan, Nancy Cohen RN, and Kay Clements for administrative support, medical coding, and clinical input, and to Gail Scott for editing.

Dr. Faught has served as a consultant for Aprecia, Biogen, Eisai and UCB Pharma, and as a Data-Safety Monitoring Board member for Eisai, Lundbeck, SAGE, and SK Life Science. He has received research funding from Brain Sentinel, Neuropace, the University of Alabama at Birmingham, and UCB Pharma. He is on the editorial board of Epilepsy Currents, and was on the Medicare Evidence Development and Coverage Advisory Committee of the Center for Medicare and Medicaid Services 2011–2014, and was Chair of the Treatments Committee of the American Epilepsy Society 2012–15.

Dr. Szaflarski has received research funding from the National Institutes of Health, Shor Foundaton for Epilepsy Research, Epilepsy Foundation of America, Food and Drug Administration, Compumedics Neuroscan Inc., Department of Defense, National Science Foundation, Eisai, and the University of Alabama at Birmingham. He is an associate editor for the Journal of Epileptology and Restorative Neurology and Neuroscience and serves on editorial boards for Conference Papers in Medicine, Epilepsy and Behavior, Folia Medica Copernica, and the Journal of Medical Science.

Dr. Martin has received research funding from the National Institutes of Health and the University of Alabama at Birmingham. He serves on the editorial board for Epilepsy Currents.

Drs. Funkhouser, Richman, Piper, Pisu, and Ms. Juarez and Mr. Dai report no conflicts.

Subjects:

Research Funding:

This study was funded by the National Institute of Neurological Disorders and Stroke (1RO1NS080898–01, Maria Pisu, Principal Investigator)

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences & Neurology
  • antiepileptic drugs
  • epilepsy
  • ethnicity
  • interactions
  • race
  • seizures
  • NEW-ONSET EPILEPSY
  • CLINICAL COMORBIDITY INDEX
  • MEDICARE BENEFICIARIES
  • CARE
  • VETERANS
  • SEIZURES
  • QUALITY
  • CHOICE
  • ADULTS
  • US

Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk

Tools:

Journal Title:

Epilepsia

Volume:

Volume 59, Number 3

Publisher:

, Pages 715-723

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: To determine the frequency of older Americans with epilepsy receiving concomitant prescriptions for antiepileptic drugs (AEDs) and non-epilepsy drugs (NEDs) which could result in significant pharmacokinetic (PK) interaction, and to assess the contributions of racial/ethnic, socioeconomic, and demographic factors. Methods: Retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries ≥67 years old in 2009 augmented for minority representation. Prevalent cases had ≥1 ICD-9 345.x or ≥2 ICD-9 780.3x, and ≥1 AED. Among them, incident cases had no seizure/epilepsy claim codes nor AEDs in preceding 365 days. Drug claims for AEDs, and for the 50 most common NEDs within +/− 60 days of the index epilepsy date were tabulated. Interacting pairs of AEDs/NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Results: Interacting drug pairs affecting NED efficacy were found in 24.5% of incident, 39% of prevalent cases. Combinations affecting AED efficacy were found in 20.4% of incident, 29.3% of prevalent cases. Factors predicting higher interaction risk included having ≥ 1 comorbidity, being eligible for Part D low Income Subsidy, and not living in the northeastern US. Protective factors were Asian race/ethnicity, and treatment by a neurologist. Significance: A substantial portion of older epilepsy patients received NED-AED combinations that could cause important PK interactions. The lower frequency among incident vs. prevalent cases may reflect changes in prescribing practices. Avoidance of interacting AEDs is feasible for most persons because of the availability of newer drugs.

Copyright information:

Wiley Periodicals, Inc. © 2018 International League Against Epilepsy

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