Antiepileptic drug prescription in Dutch children from 2006-2014 using pharmacy-dispensing data

In the last two decades several new antiepileptic drugs (AEDs) have become available. The aim of our study was to analyse whether and how AED prescribing patterns in Dutch children have changed during the last decade and whether these changes were supported by guidelines and results from recently available trials.

From a large community pharmacy-dispensing database in the Netherlands, we identified children aged 0-19 years who received at least one prescription for an AED between 2006 and 2014. Children who also received prescriptions for migraine or psychiatric disorders were excluded. We calculated year-prevalences and -incidences of AED use with emphasis on old versus new AEDs, and individual AEDs. We evaluated these results, including the course of AED prescribing.

During the study period, the prescribing prevalence of old AEDs decreased from 1.61 per 1000 (95% C.I. 1.40-1.82) to 1.39 per 1000 (95% C.I. 1.18-1.60); for new AEDs it increased from 0.58 per 1000 (95% C.I. 0.45-0.71) to 1.35 per 1000 (95% C.I. 1.14-1.56). Valproic acid was the most frequently initiated AED in 2006. From 2010, prescribing of old and new AEDs became equal with levetiracetam as the most often initiated AED since 2012. This drug was recommended for all seizure types in the 2013 Dutch national epilepsy guideline. Only 5.5% of the children used AED combination therapy. Of those on monotherapy, 85.7% remained on the first prescribed AED.

In the last 10 years, prescribing of new AEDs increased at the expense of old AEDs. Levetiracetam has replaced valproic acid as the most frequently prescribed first line antiepileptic drug in children since 2012, which is in line with national guidelines.