Photo Credit: Yuliya Baranych
The impact of overall medication burden on QOL for patients with epilepsy underscores the need to periodically assess antiseizure drug load for these patients.
“Quantification of [antiseizure medication] drug load, a measure that considers both the number of medications and the doses of each drug in a treatment regimen, provides a more precise measure of drug burden in patients with epilepsy than the number of [antiseizure medications] alone,” Gregory S. Connor, MD, and colleagues wrote in a study published in Epilepsy & Behavior. “When adding on [antiseizure medication] treatment, adjustment of concomitant [antiseizure medications] is recommended to achieve seizure control with the lowest possible drug load in order to minimize treatment-related adverse events.”
Increased antiseizure drug load is associated with adverse events, particularly cognitive impairment, Dr. Connor notes. “Since QOL issues are as important as seizure control to most patients with epilepsy, we believe more attention should be made to drug burden. Not enough attention has been placed to the idea of reducing previous antiseizure medications when a new one is added.”
For the retrospective observational study, Dr. Connor and colleagues used US claims data to examine changes in antiseizure medication drug load among 21,332 adults with epilepsy. Physician’s Weekly (PW) spoke with Dr. Connor to learn more about the study results.
PW: What prompted this research?
Dr. Connor: While pivotal trials and their follow-up studies can give some insight about whether the addition of a new adjunctive drug can reduce some of the overall drug burden, these studies are confined to patients with refractory disease, and the information may, therefore, not apply to the real-world treatment of epilepsy. We wanted to see what happens to medication burden when new adjunctive treatments are added in the real world.
What were the primary findings?
First and foremost, the average total antiseizure medication burden increased between 2016 and 2020, and we know that the total number of medications is associated with increased adverse events. Clinicians need to be aware of this fact and look for opportunities to lower medication loads.
The finding of an overall increased medication burden concerned us for multiple reasons. First, there are more adverse events, especially cognitive impairment, but we know these adverse events may be mitigated by a decrease in medication burden. There are also pharmacokinetic and pharmacodynamic interactions that may be harder to predict when numerous medications are combined. Other medications patients may be taking include nonseizure medication, such as birth control pills and psychiatric medications.
Further, costs are always a concern for patients—and, quite simply, patients just want to take fewer medications.
What are the implications of these results?
This study sheds light on an issue clinicians may not think about regularly. Since neurologists’ most pressing concern is helping their patients attain seizure freedom, they may not be as focused on the medication burden and its long-term consequences.
Not enough attention is placed on the total antiseizure medication burden. We hope that clinicians use this information to periodically assess their patients’ medication burden and at least consider the possibility of removing or lowering medications.
What are the next steps in this research?
We hope to repeat this study with newer medications, for which it has been shown that substantial reductions of concomitant medications could be achieved without compromising seizure control, therefore resulting in improved QOL.
Also, as I mentioned earlier, the patients included in this study may not represent the real-world treatment of epilepsy. A dataset similar to the one used in this study would be useful in delineating whether newer antiseizure medications can truly reduce the medication burden for the average patient with epilepsy.
