PhD Candidate Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia
Background: Post-stroke epilepsy is an important complication which may increase the risk of recurrent stroke and mortality. However, there are no clinical guidelines on the appropriate use of antiepileptic drugs (AED) in post-stroke cohorts.
Objectives: This study aimed to investigate trends in the utilisation of AED using Daily Defined Dose (DDD) and examine predictors of AED utilisation in people with ischemic stroke using the Victorian linked health database.
Methods: Patients aged ≥30 years old and discharged from Victorian hospitals following ischemic stroke between July 2013 and June 2017 were included. The average DDD of AED dispensed per person per day during the 1-year follow-up after discharge was estimated. Logistic regression was used to identify predictors of receiving new-generation AEDs. Generalised linear model was used to examine the factors associated with the AED utilisation.
Results: Between 2013 and 2017, there was a noticeable shift in the use of newer-generation anti-seizure medications (ASMs) (OR 2.82, 95% CI 1.92-4.16). A small decline in the average DDD per day per person was observed from 2013/14 to 2016/17 (0.36 DDD per day per person in 2013/14 to 0.34 DDD per day per person in 2016/17). Compared to people aged 30-59 years, those aged 75-84 years were associated with higher consumption of AEDs (β 0.23; p-value 0.030). Females (β -0.18; p-value 0.008) and people who were married or in a de facto relationship (β -0.21; p-value 0.004) had lower DDD of ASM than males or those who were single, respectively. People who received multiple types of ASMs (β 0.78; p-value <0.001) during the study period and received newer-generation ASM (β 0.23; p-value 0.001) as their first treatment had higher DDD per day compared to those who received a single type of ASM or older-generation ASM, respectively. Moreover, receiving beta-blockers prior to stroke was associated with higher DDD of ASM per day (β 0.17; p-value 0.030).
Conclusions: There has been a trend towards receiving newer generation AEDs over older generation. Older age, a history of beta blocker use, taking multiple ASMs, and using newer-generation ASMs were associated with higher DDD of ASM. Conversely, female sex and being in a marital or non-marital relationship were associated with lower DDD of ASM. Further research is needed to assess the effectiveness of AEDs in controlling post-stroke seizures and epilepsy.
