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Medication Utilization Patterns 90 Days Before Initiation of Treatment with Repository Corticotropin Injection in
Laura S Gold1,2, Tara A Nazareth3, Tzy-Chyi Yu3
1Department of Radiology, University of Washington, Seattle, WA, USA.
Insights
Infantile spasms (IS) patients often receive multiple treatments before H.P. Acthar Gel (repository corticotropin injection, RCI). Starting RCI first was linked to lower healthcare resource utilization (HCRU) compared to other therapies.
Area of Science:
- Pediatric Neurology
- Epileptology
- Health Services Research
Background:
- Infantile spasms (IS) is a severe early childhood epilepsy with limited approved treatments.
- H.P. Acthar Gel (repository corticotropin injection, RCI) and Sabril (vigabatrin) are US-approved IS therapies.
- Real-world treatment variations necessitate understanding IS medication patterns and associated healthcare costs.
Purpose of the Study:
- To characterize treatment patterns for infantile spasms (IS) in the US.
- To determine all-cause healthcare resource utilization (HCRU) in the 90 days preceding RCI initiation for IS.
- To compare HCRU based on initial IS treatment strategies.
Main Methods:
- Utilized Truven Health MarketScan Research Databases for US patients under 2 years old with IS.
- Included patients initiating RCI between 2007 and 2015, requiring an electroencephalogram for diagnosis confirmation.
- Evaluated IS diagnoses and dispensed treatments (corticosteroids, vigabatrin, other antiepileptic drugs [AEDs]) prior to RCI.
Main Results:
- Of 422 IS patients, 51.7% received RCI first; 38.9% received one prior drug class, and 9.5% received multiple prior drug classes.
- Other AEDs were the most frequently dispensed prior treatments.
- Patients initiating RCI or corticosteroids first exhibited the lowest HCRU.
Conclusions:
- IS patients frequently received multiple diagnoses and treatments before RCI initiation, with significant HCRU.
- Initiating RCI as the first IS treatment was associated with the lowest HCRU.
- Prior use of antiepileptic drugs (AEDs) before RCI was linked to the highest HCRU.
Introduction:
Infantile spasms (IS) is a rare and devastating form of early childhood epilepsy. Two drugs are approved in the United States for treatment of IS, H.P. Acthar® Gel (repository corticotropin injection, RCI) and Sabril® (vigabatrin). Given real-world variation in treatment of patients with IS, this study characterized treatment patterns with IS medications and determined all-cause health care resource utilization (HCRU) during the 90 days before initiating therapy with RCI in patients with IS.
Materials And Methods:
Truven Health MarketScan® Research Databases were used to identify commercially insured US patients <2 years of age at RCI initiation with an IS diagnosis, per label use, from 1/1/07 to 12/31/15; presence of an electroencephalogram following diagnosis was required to assure diagnosis. Diagnosis codes and dispensed IS treatments of interest (drug classes including corticosteroids, vigabatrin, and other antiepileptic drugs [AEDs] excluding vigabatrin) before RCI initiation were evaluated.
Results:
The 5 most common diagnoses other than IS observed in the study cohort (n=422) were "other convulsions," "acute upper respiratory infection," "esophageal reflux," "epilepsy, unspecified," and "abnormal involuntary muscle movements." Among the study cohort, 51.7% received RCI first; 38.9% received 1 drug class and 9.5% received >1 drug class before RCI initiation. Other AEDs were dispensed most often, either alone (31.3%) or with other drug classes (9.3%). Mean HCRU included 11.8 all-cause outpatient visits and 4.5 medications dispensed. Patients who received RCI or corticosteroids as their initial IS treatment had the lowest and second-lowest HCRU.
Conclusion:
In the 90 days before initiating RCI, patients with IS received multiple diagnoses and treatments, characterized by frequent HCRU. Use of RCI first (no prior IS medications) and AEDs first were associated with the lowest and highest HCRU, respectively, across all categories (all-cause outpatient visits, emergency department visits, hospital admissions, prescription medications).
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