Abstracts

Rationale: To inform the treatment of epilepsy, there remains a need to understand how antiepileptic drugs (AEDs) are used in the U.S. health care community. Rufinamide is an AED indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in children 4 years and older and adults. Using a retrospective analysis of medical and pharmacy claims, we conducted a study to evaluate the demographic and socioeconomic characteristics of patients prescribed rufinamide across the age spectrum. Methods: Continuously enrolled patients with medical and pharmacy benefits in the Optum™ database, who had at least two prescription claims for rufinamide, were identified from January 2009 to September 2013. Of the total number of patients with rufinamide prescription claims (n=1,589), 361 patients met the inclusion criteria for the study. Data was examined 6 months prior to (preindex), and 12 months following (followup) the index prescription of rufinamide. Variables examined included age, gender, Charlson Comorbidity Index (CCI), health insurance, physician specialty, hospitalizations and emergency room visits, and other health care utilization. Results: Of the patients prescribed rufinamide, the majority were commercially insured (91%) and had a previous diagnosis of epilepsy (94%). More patients were aged 1-17 (n=210, 58%) than were >18 years old (n=151, 42%). While the Charlson comorbidity mean scores suggests that identified patients were generally healthy, 28% and 37% were hospitalized in the pre-index and follow-up periods, respectively. For patients prescribed rufinamide and hospitalized for epilepsy, the leading diagnoses were Unspecified Epilepsy without Intractable Epilepsy (ICD-9-CM=345.90) (36%), Unspecified Epilepsy with Intractable Epilepsy (345.91) (34%), and Generalized Convulsive Epilepsy with Intractable Epilepsy (345.11) (28%). Neurologists (80%) and primary care physicians (PCPs) (12%) were the main prescribers of rufinamide at index. Among PCPs, pediatricians accounted the highest percentage of prescriptions. Conclusions: The results of this study highlight several important points. First, the differences in the proportion of patients by age suggest that rufinamide is typically used soon after a diagnosis of epilepsy. In addition, based on ICD9 codes, patients receiving rufinamide have high rates of intractable epilepsy, suggesting that although this AED is being prescribed to young patients, it is being reserved for use later in the treatment algorithm. Finally, the pediatric PCP appears to play an important role in the prescribing of rufinamide. Since there is no ICD-9 code specific for LGS, it remains unclear whether the rufinamide used here was for the treatment of LGS, a limitation of this study. These conclusions, therefore, will require further exploration.