Real-world analysis of hospitalizations in patients with epilepsy and treated with perampanel.

Abstract

Objectives(1) To evaluate risk of hospitalization following initiation of perampanel (pre‐ and post‐analysis) and (2) to compare hospitalization rates following initiation of perampanel vs lacosamide.MethodsPatients were identified from Symphony Health's Patient Integrated Database if they had a prescription for perampanel (July 1, 2014‐June 30, 2016). Patients 4‐11 years of age with any partial‐onset seizure (POS) or ≥12 years of age with any POS or primary generalized tonic‐clonic seizure (GTCS) (pre‐post); or ≥12 years of age (perampanel vs lacosamide). The first fill of perampanel (“index date”) marked the start of the analysis period. Patients had ≥1 additional fill for perampanel and ≥2 diagnoses for epilepsy or nonfebrile convulsion diagnosis during pre‐index (based on ICD‐9/ICD‐10 codes). Patients were matched using a 1:1 propensity scoring method for the perampanel vs lacosamide analysis. Primary outcome was hospitalization during the one year following medication initiation.ResultsPre‐ and post‐perampanel: N = 1771 (mean age 34 years, 55% female). One‐year all‐cause hospitalization risk ratio was 0.76 (P < .05) and 36.2% with hospitalization during the pre‐period vs 29.5% in the follow‐up. One‐year epilepsy‐related inpatient hospitalization risk ratio was 0.72 (P < .05) and 30.8% with hospitalization during the pre‐period vs 23.9% during follow‐up. In the perampanel and lacosamide cohorts, N = 1717 per cohort after matching, most baseline demographics were balanced. A higher percentage of subjects were prescribed ≥3 anti‐seizure medications for perampanel vs lacosamide (60.5% vs 57.7%, P < .001). The perampanel cohort had a 9.6% reduction in all‐cause hospitalizations vs 5.8% for the lacosamide cohort (P < .05). Epilepsy‐related hospitalizations decreased from the pre‐index rate by 9.9% for perampanel and 8.3% for lacosamide (P < .05). Among those with baseline hospitalizations, perampanel was associated with a 59.9% reduction in all‐cause hospitalizations vs 48.6% for lacosamide (P < .05), and for epilepsy‐related hospitalizations, a reduction of 65.0% vs 58.9%, respectively (P < .05).SignificancePerampanel was associated with a significant reduction in one‐year hospitalization risk.