Teratogenic antiepileptics often used in young women

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By Reuters Staff

NEW YORK (Reuters Health) - Many women of childbearing age with epilepsy are treated with teratogenic antiepileptic drugs (AEDs), according to a large population-based study.

"Many women appear to receive valproate, topiramate, and phenytoin despite known teratogenicity risks," researchers write in JAMA Neurology, online April 1. "Comorbidities may be likely to affect selecting certain AEDs despite their teratogenicity risks. This finding suggests that physicians and women of childbearing age with epilepsy should be aware of and sensitive to teratogenicity risks of certain AEDs."

Used data from a nationwide commercial database and supplemental Medicare and Medicaid insurance claims, Dr. Hyunmi Kim of Stanford University School of Medicine in Palo Alto, California, and colleagues identified more than 46,000 women between 15 and 44 years of age with epilepsy and continuous medical and pharmacy enrollment from 2009 through 2013.

For incident cases, the women's mean age was 27 years, and for prevalent cases it was 30 years. Of the 3,219 women in the incident epilepsy group who received AEDs for 90 days or longer, 98.6% received monotherapy as first-line treatment. Of the 28,239 treated prevalent cases, 67.2% received monotherapy.

For incident cases on monotherapy, the AEDs most commonly prescribed as first-line treatment were levetiracetam (39.7%), topiramate (15.4%) and lamotrigine (15.3%). For prevalent cases on monotherapy, the most popular AEDs were lamotrigine (20.7%), levetiracetam (19.4%), topiramate (12.6%), carbamazepine (10.7%) and valproate (10.2%).

Valproate was more often prescribed for women with comorbid headache or migraine, mood disorder and anxiety and dissociative disorders, while topiramate was used more commonly for women with comorbid headache or migraine. Overall, valproate sodium and phenytoin sodium were more commonly used for generalized epilepsy, while oxcarbazepine was more often used for focal epilepsy.

"Efforts to raise awareness of current American Academy of Neurology quality measures on the counseling of teratogenicity risk may assist in ensuring that the risk-benefit profiles of treatments are evaluated by both clinicians and patients," the authors advise. "Treatment patterns for women of childbearing age with epilepsy should continue to be monitored through population-based studies."

UCB Pharma funded the study but played no role in its design, conduct, or publication. All authors reported financial relationships with the company.

SOURCE: https://bit.ly/2KvKRXQ

JAMA Neurol 2019.

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