(C26) A Review of Existing Clinical Guideline Recommendations for Contraceptive Selection in Women with Epilepsy with a Focus on Drug-Drug Interactions

Publication Number: 970

Background: Medical practice is largely dictated by recommendations contained within clinical guidelines and there may be significant heterogeneity in the quality of these articles which may in turn lead to suboptimal outcomes in the populations to which they pertain. Women with epilepsy (WWE) require high quality, scientifically sound clinical guidance as they demand a unique standard of care, in part due to the risk of clinically significant drug-drug interactions between hormonal contraceptive agents (HCAs) and antiepileptic drugs (AEDs).

Objectives: To identify and evaluate existing clinical treatment guidelines related to the use of HCAs in WWE receiving concomitant disease management with AEDs.

Methods: Guidelines relevant to clinical practice in either the United States or Canada were identified through keyword searches across four biomedical bibliographic databases. Guidelines were screened for eligibility and excluded based on prespecified criteria.
Five investigators independently evaluated the literature utilizing the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) Tool and the overall scores were aggregated and adjudicated by an independent third party. The threshold scaled score established indicative of a good quality article was 80%.

Results: A total of 7 guidelines meeting the eligibility criteria were identified and evaluated. The scaled scores from the individual domains ranged from 0% to 100%, while overall scores ranged from 17% to 92%. Of these 7 guidelines, those published by the World Health Organization (WHO) and United States Centers for Disease Control and Prevention (CDC) were highly rated in most domains as compared to others, receiving overall scores of 92% and 84%, respectively. Most guidelines performed well in the domains of Scope and Purpose and Clarity of Presentation. Contrastingly, many scored poorly in the domain of applicability.
Specific and key recommendations from each of the seven guideline documents were extracted and summarized. Combined Oral Contraceptives (COCs) were the only modality mentioned in all clinical guidance documents, and only 3 of the 7 articles addressed all contraceptive options. A key discordance was noted with regard to recommendations related to the contraceptive implant.

Conclusions: In conclusion, the WHO and CDC guidelines were the most highly scored documents evaluated. Many recommendations between these articles were congruent with the exception of those regarding contraceptive implants. In WWE, there is a requirement for high-quality clinical guidelines that adhere to the most recent scientific evidence.