Antiepileptic Drug (AED) Treatment in Juvenile Myoclonic Epilepsy (JME): a Population-based Study

Objective: To examine the prevalence of intractable Juvenile Myoclonic Epilepsy (JME) and to investigate differences in antiepileptic drugs (AEDs) treatment between persons with and without intractability. Background: Most JME are considered to be responsive to appropriate AEDs. However, little is reported about AED treatment patterns, such as treatment regimen and doses. Design/Methods: We performed a population-based study using a U.S. nationwide claims database from the OptumO ClinformaticsO Data Mart (10/2015–12/2017). JME cases were identified by ICD-10-CM diagnosis codes. We analyzed 22 AEDs. Outcomes were the frequency of intractable JME and differences in treatment regimen (i.e., monotherapy, polytherapy, and switched regimen) and doses (i.e., lower and higher than defined daily doses measured by prescribed daily dose (PDD)/defined daily dose (DDD) ratio) between persons with and without intractability, controlling for demographic characteristics, socioeconomic status, and psychiatric comorbidity. Results: Among 1530 persons with JME (median [IQR] age=26 [9–37] years; female=915 [59.8%]), 313 (20.5%) had intractability. AEDs were prescribed in 1406 (91.9%). Monotherapy was prevalent in non-intractable JME relative to intractable JME (63.0% vs. 37.8%, p=0.000). Polytherapy and switched regimen were frequently prescribed in both non-intractable (19.2% and 17.8%) and intractable JME (27.1% and 35.1%). After controlling for age, sex, race, education level, household incomes, and psychiatric comorbidity, persons with intractable JME were more likely to undergo polytherapy (OR=2.4, 95% CI=1.2–4.7, p=0.013) and switched regimen (OR=2.5, 95% CI=1.3–4.9, p=0.009). High-dose ratio (PDD/DDD>1) was prevalent in most commonly prescribed 5 AEDs for both non-intractable and intractable JME: levetiracetam (40.6% vs. 58.6%, p=0.000), lamotrigine (51.7% vs. 63.3%, p=0.033), valproic acid (13.6% vs. 20.8%, p=0.153), zonisamide (66.9% vs. 76.6%, p=0.234), and topiramate (16.0% vs.36.2%, p=0.010). Conclusions: Polytherapy, switched regimen, as well as high-dose AEDs were frequently applied for JME treatment regardless of intractability. This finding suggests that JME is less likely to have a benign course. Disclosure: Dr. Oh has nothing to disclose. Dr. Kim has nothing to disclose.