Long-Acting Antiepileptic Drugs Decrease Epilepsy Care Use

Compared with those receiving short-acting antiepileptic drugs (AEDs), patients with epilepsy taking long-acting AEDs use fewer health care services and have lower related care costs.

For a study published in Epilepsy & Behavior, a multifaceted team of researchers compared long-acting and short-acting AED monotherapy in order “to understand whether AEDs with intrinsically long duration of action provide better outcomes,” corresponding study author Joyce A. Cramer, BS, an associate research scientist in the Department of Psychiatry at Yale University School of Medicine, explained to Pharmacy Times in an exclusive interview.

The researchers relied on medical and pharmacy claims to estimate health care use and expenses among the 8180 study subjects, of whom 4058 used long-acting AEDs and 4122 used short-acting AEDs. Long-acting AEDs included phenytoin extended release (ER), carbamazepine ER, topiramate, divalproex ER, divalproex delayed release, phenobarbital, levetiracetam ER, and zonisamide, while short-acting AEDs included levetiracetam, lamotrigine, carbamazepine, and oxcarbazepine.

According to the authors, long-acting AED users were typically older and had fewer chronic conditions and epilepsy-specific comorbidities than shot-acting AED users, who were more often female. Both cohorts received their care most frequently from physicians, followed by neurologists and other specialists.

Although medication adherence was not significantly different between both groups, long-acting AED users had significantly lower annual health care costs compared with the short-acting AET group ($9757 versus $21,634, respectively). Similarly, epilepsy-related annual health care costs were lower in the long-acting AED users compared with the short-acting AED users ($3539 versus $5279, respectively).

“Despite similar adherence rates, patients did better with long-acting AEDs,” Cramer told Pharmacy Times, mentioning that she found the result surprising. “We thought there might be a correlation with adherence rates. The results generally argue against generic substitution with short-acting medications because this may not sacrifice overall costs.”

The researchers commented that prior research determined that epilepsy medication adherence is a large problem. Lack of adherence has been linked to increased burden of illness, though educational and behavioral interventions can sometimes improve adherence to AEDs.

“Duration of action of an AED may have important implications in overall health outcomes and overall costs, even if the drug is tier 3,” Cramer told Pharmacy Times. “Counseling about adherence remains very important, but the doctor’s choice of a long-acting AED is valuable in controlling epilepsy as well as costs.”