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Antiepileptic drug use in Italian children over a decade
Daria Putignano1, Antonio Clavenna2, Rita Campi1
1Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156, Milan, Italy.
Insights
Older antiepileptic drugs (AEDs), like valproic acid, are common first treatments for pediatric epilepsy. Most children tolerated their initial AED prescription well, indicating effective treatment for many young epilepsy patients.
Area of Science:
- Pediatric Neurology
- Pharmacovigilance
- Health Services Research
Background:
- Epilepsy affects a significant number of children, requiring long-term management with antiepileptic drugs (AEDs).
- Understanding prescription patterns and treatment outcomes is crucial for optimizing pediatric epilepsy care.
- Administrative health databases offer valuable insights into real-world drug utilization and healthcare utilization in pediatric populations.
Purpose of the Study:
- To analyze the prescription profiles of antiepileptic drugs (AEDs) in pediatric epilepsy patients.
- To evaluate hospitalization rates and specialist visit frequency in this population.
- To identify trends in AED use and treatment persistence.
Main Methods:
- Retrospective analysis of administrative health databases from Italy's Lombardy Region (2003-2010).
- Inclusion of pediatric patients (0-16 years) with at least seven AED prescriptions over two consecutive years.
- Monitoring of drug prescriptions, specialist visits, diagnostic tests, and hospitalizations for incident cases in the 24 months post-index prescription.
Main Results:
- 6527 incident cases of pediatric epilepsy were identified.
- Valproic acid (65.9%) and carbamazepine (15.0%) were the most frequently prescribed AEDs, with increasing use of newer agents over time.
- 74% of patients continued their initial AED, with higher treatment change rates in preschoolers (34%).
- 21% of incident cases were hospitalized for epilepsy, and 86% had specialist visits within 24 months of the first AED prescription.
Conclusions:
- Older AEDs, particularly valproic acid, remain the primary therapeutic choice for pediatric epilepsy in Italy.
- Initial AED treatment appears effective and well-tolerated in approximately three-quarters of pediatric epilepsy cases.
- The study highlights the importance of monitoring healthcare utilization alongside pharmacotherapy in managing pediatric epilepsy.
Purpose:
The aim of the study was to evaluate prescription profiles of antiepileptic drugs (AEDs) and to assess hospitalizations and specialist visits in pediatric patients with epilepsy.
Methods:
The data sources were administrative health databases of Italy's Lombardy Region, which collect prescriptions for drugs, diagnostic tests, specialist visits, and hospital discharge forms. All patients aged 0-16 years with at least seven AED (group N03A of the International Anatomical Therapeutic Chemical Classification) prescriptions over two consecutive years between 2003 and 2010 were identified and classified as prevalent or incident cases (no prescriptions in two previous years). The first prescription to incident cases was analyzed. For each incident case, drug prescriptions, specialist visits, diagnostic tests, and hospitalizations in the 24 months following the first (index) prescription were monitored.
Results:
A total of 6527 incident cases (5.4/10,000 person-years, 95% CI 5.4-5.5) were identified. Valproic acid and carbamazepine were the most prescribed drugs (65.9 and 15.0%, respectively). The use of newer AEDs increased over time. In the 24-month observation period, 74% of incident cases continued the treatment with the index AED. The percentage of cases who changed therapy was higher in preschoolers (34%) and decreased with age. In all, 21% of incident cases were hospitalized for epilepsy and 86% had a specialist visit in the 24 months after the first AED prescription.
Conclusions:
In conclusion, older AEDs, particularly valproic acid, remained the first therapeutic approach to pediatric epilepsy in Italy. For three quarters of cases, the initial AED treatment was likely effective and well tolerated.
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