Effects of antiepileptic drug substitutions on epileptic events requiring acute care.
OBJECTIVE
To determine the odds of antiepileptic drug substitution among patients who had an epileptic event requiring acute care-ambulance service, emergency department visit, or hospitalization-relative to patients who did not have an event, and to compare these results with those from a recent study involving a similar method but different patients.


METHODS
Case-control analysis.


METHODS
United States health care claims from the PharMetrics database.


METHODS
A cohort of patients aged 12-64 years with a primary diagnosis of epilepsy between October 1, 2005, and December 31, 2006; 991 cases (patients who experienced an epileptic event requiring acute care) and 2973 controls (patients who did not have an event) were matched in a 1:3 ratio for sex, age, and type of epilepsy.


RESULTS
Using discordant pairs analysis, we calculated the odds ratio of an epileptic event that required acute care occurring in patients whose antiepileptic drug underwent substitution to an A-rated (therapeutically equivalent) alternative (switch from branded product to generic, generic to branded, or generic to generic) versus those whose drugs were not substituted. For matched data, 109 (11.0%) of 991 cases had an A-rated antiepileptic drug substitution in the 6 months before the event, whereas only 186 (6.3%) of 2973 controls had a substitution (odds ratio 1.84, 95% confidence interval 1.44-2.36). Our results were similar to those of a previous study involving a different patient database, which showed substitution rates of 11.3% for cases versus 6.5% for controls (odds ratio 1.81, 95% confidence interval 1.25-2.63). Our sensitivity analyses were robust, and we found a temporal relationship in that numerous substitutions occurred in the month before the acute event.


CONCLUSIONS
Patients who had an epileptic event requiring acute care were about 80% more likely than matched controls without an acute event to have recently had an antiepileptic drug substitution. Our replication of a previously published case-control analysis revealed a similar association between substitution involving A-rated antiepileptic drugs and subsequent epileptic events requiring acute care, thereby lending credibility to the findings.
Rascati
Karen L
KL
College of Pharmacy and the Center for Pharmacoeconomic Studies, The University of Texas, Austin, Texas 78712, USA. krascati@mail.utexas.edu
Richards
Kristin M
KM
Johnsrud
Michael T
MT
Mann
Teresa A
TA
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D016022:Case-Control Studies; D002648:Child; D016208:Databases, Factual; D016568:Drugs, Generic / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D013810:Therapeutic Equivalency; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000927:Anticonvulsants; D016568:Drugs, Generic