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Leinonen MK, Igland J, Dreier JW, Alvestad S, Cohen JM, Gilhus NE, Gissler M, Sun Y, Tomson T, Zoega H, Vegrim HM, Christensen J, Bjørk MH. Socioeconomic differences in use of antiseizure medication in pregnancies with maternal epilepsy: A population-based study from Nordic universal health care systems. Epilepsia 2024. [PMID: 38804650 DOI: 10.1111/epi.18022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy. METHODS We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference. RESULTS Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36). SIGNIFICANCE Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.
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Affiliation(s)
- Maarit K Leinonen
- Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland
- Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Julie Werenberg Dreier
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Silje Alvestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Oslo, Norway
| | - Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yuelian Sun
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Håkon M Vegrim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marte-Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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Rutkovska I, Seilis A, Neikena Z, Poplavska E. Impact of Risk Minimisation Measures on Valproate Use among Women of Reproductive Age in Latvia Between 2013 and 2020: A 7-Year Nationwide Prescription Database Study. Drugs Real World Outcomes 2023; 10:639-649. [PMID: 37821776 PMCID: PMC10730785 DOI: 10.1007/s40801-023-00394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND A relevant safety concern for the use of valproate (VPA) in women of reproductive age is its teratogenicity. In 2014 European Medicines Agency (EMA) introduced risk minimisation measures (RMMs) to reduce the VPA use by women of reproductive age, where the impact on VPA use was not as large as expected. In 2018, the EMA introduced additional RMMs, and it is essential to assess impact of these interventions. OBJECTIVE The objective of this study was to evaluate the impact of the EMA-published RMMs in 2014 and 2018 on the prevalence of VPA use and to describe trends in the prevalence rate and incidence proportion of VPA use in epilepsy, bipolar disorder and off-label indications in Latvia. METHODS This was a nationwide population-based study using a primary care prescription database. The study included women in age groups < 15, 15-49 and > 49 years and men in age group 15-49 years who have received VPA. This study assessed the prevalence rate and the incidence proportion of VPA use. The impact of RMMs on the two study intervention periods [fourth quarter (Q4) 2014 and Q4 2018] in men and women was evaluated using causal impact analysis. RESULTS In the study cohort, VPA use in women in the age group 15-49 years decreased after the first and second intervention periods, where after the first intervention period the relative reduction in prevalence of VPA consumption was -7.7 [95% confidence interval (CI) -10%, -5.1%] and after both study periods -6.4% (95% CI -11%, -1.5%). In girls < 15 years of age, valproate use decreased after both intervention periods, while in women > 49 years old VPA use increased. In men aged 15-49 years, an increase after the first period and a non-significant decrease after both intervention periods was observed. The prevalence of valproate use in girls < 15 years and women 15-49 years of age with bipolar disorder, epilepsy and off-label indications decreased per 1000 people during the study period. The incidence proportion of VPA use in women aged 15-49 years decreased each year since the beginning of the study period. CONCLUSIONS A statistically significant decrease in the prevalence of VPA use was identified among girls < 15 years and women 15-49 years of age. In Latvia, an overall good reaction to the EMA RMMs was observed. The effects go beyond the target population and affect the use of VPA in young girls as well.
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Affiliation(s)
- Ieva Rutkovska
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia.
- Department of Applied Pharmacy, Faculty of Pharmacy, Riga Stradins University, Konsula Street 21, Riga, 1007, Latvia.
| | - Andis Seilis
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia
| | - Zane Neikena
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia
| | - Elita Poplavska
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia
- Department of Applied Pharmacy, Faculty of Pharmacy, Riga Stradins University, Konsula Street 21, Riga, 1007, Latvia
- Institute of Public Health, Riga Stradins University, Kronvalda bulvaris 9, Riga, 1010, Latvia
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