Initial Monotherapy and Further Anti-seizure Medication Regimens in Adult Patients with Epilepsy: A Population-Based, Longitudinal, Retrospective Analysis of German Prescription Data

In Germany, approximately 30% of people with epilepsy do not achieve seizure control with anti-seizure medication (ASM). ASM prescription timing and selection are crucial parameters affecting outcomes; however, the prescription characteristics of patients with refractory epilepsy in Germany are poorly understood. Therefore, understanding the pathways of how patients start their first ASM regimen and change to new ASM regimens could be a crucial step towards optimising therapeutic strategies and reducing the negative consequences of uncontrolled seizures. A retrospective, population-based analysis was carried out using data from the German IQVIA™ Disease Analyzer (DA) and Longitudinal Prescriptions (LRx) databases. Over a 5-year period from 2018 to 2022, approximately 80% of Statutory Health Insurance (SHI)-reimbursed prescriptions were covered. Filtering processes were used to select and analyse patients treated only for epilepsy, and their prescription journeys. Prevalence and incidence in the selected group was in line with other reported data. Over a third of patients (36.6%) waited ≥ 1 day to receive their first ASM regimen prescription, and all patients stayed on their first ASM regimen for the longest period. Time to change from first and further regimens was on average > 300 days. Levetiracetam was the most prescribed ASM, and newer ASMs licensed in the past decade had much lower prescriptions. Prescribing differences were observed between specialities. This analysis contributes to the understanding of current epilepsy treatment shortfalls, showing delays in time to treatment and time to regimen change, and relatively low use of more recent ASMs. Additional work is required to evaluate how much improvement in outcome could be achieved by advancing first prescription timing and ASM selection, which may help reduce epilepsy disease burden. In Germany, about one in three people with epilepsy continue to have seizures even when taking anti-seizure medicines. This is called refractory epilepsy. It is important to understand what it is about the use of epilepsy medicines that might help improve epilepsy symptoms and stop or reduce seizures. Doctors and patients must make choices such as when to start an epilepsy medicine, which medicine to give, and when to try a different medicine. However, not a lot is known about these choices, especially for the group of patients who continue to have seizures. To find out more, the authors of this paper analysed anonymous data collected about German epilepsy medicine prescriptions. They examined information on when epilepsy medicines were given, when a patient changed medicine, and which medicines were given. The results showed that many patients do not receive their initial treatment as early as possible, and obtain treatment modifications only with considerable delay. This might be because the first treatment is working well, or it might be due to a delay in trying something else. The results also showed that some newer medicines are not used very much, and that doctors with specialist knowledge about epilepsy make different choices from general practice doctors. This means that there are opportunities for improvements in the prescription of epilepsy medicines. Doctors may benefit from extra support in making prescription choices. Patients may benefit from understanding their treatment choices.