Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data
Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data
复制标题
DOI：
10.1016/j.seizure.2016.07.001
复制
发表时间：
2016-10-01
影响因子：
3
通讯作者：
Strzelczyk, Adam
中科院分区：
文献类型：
--
作者：
Ertl, Julia;Hapfelmeier, Jana;Strzelczyk, Adam
目的：检查 2008 年发布的临床实践指南“首次癫痫发作和成年期癫痫”对 2008 年至 2014 年新诊断癫痫患者的实施情况。 方法：这项回顾性、基于人群的分析是对德国法定健康保险的 410 万名被保险人的患者数据进行的。使用分层诊断选择算法，根据 ICD-10 代码识别成人中的流行病例和偶发病例。针对新诊断的癫痫患者的第一种抗惊厥药物根据临床实践指南进行了验证。结果：我们确定成人的年粗患病率在 0.946% 至 1.090% 之间，发病率至少为每 100,000 人 156 例。在局灶性癫痫综合征患者中，符合指南的单一疗法显着增加，而在特发性全身性癫痫患者中，不符合指南的单一疗法的比例有所增加。这两项变化可能是由于所有新治疗患者中左乙拉西坦处方从 2008 年的 19.6% 增加到 2014 年的 58.9%。总体而言，酶诱导抗惊厥药的比例从 2008 年的 20.7% 显着下降至 2014 年的 4.3%（p < 0.001）。 2014年接受非酶诱导抗癫痫药物的可能性比2008年高5.82（95% CI 4.62-7.33）。结论：局灶性癫痫的初始单药治疗符合现行临床实践指南，主要通过左乙拉西坦处方实施。进一步的评估应该解决这样的问题：与未按照现行指南治疗的患者相比，按照指南治疗的患者是否能获得良好的结果。 (C) 2016 年英国癫痫协会。由爱思唯尔有限公司出版。保留所有权利。
Purpose: To examine the implementation of the clinical practice guideline "first epileptic seizure and epilepsy in adulthood" published in 2008 to patients with newly diagnosed epilepsy between 2008 and 2014.Method: This retrospective, population-based analysis was performed on patient data of 4.1 million insurants from the German statutory health insurance. Prevalent and incident cases in adults were identified based on ICD-10 codes, using a hierarchical diagnosis selection algorithm. The first anticonvulsive agent in a newly diagnosed epilepsy patient was validated against the clinical practice guideline.Results: We determined an annual crude prevalence rate in adults between 0.946% and 1.090% and incidence rates of at least 156 per 100,000. A significant increase in guideline compliant monotherapy was found in patients with a focal epilepsy syndrome, while, among patients with idiopathic generalised epilepsies, the share of guideline noncompliant monotherapy increased. Both changes are likely due to the overall increase in prescription of levetiracetam from 19.6% in 2008 to 58.9% in 2014 in all newly treated patients. Overall, the proportion of enzyme-inducing anticonvulsants fell significantly from 20.7% in 2008 to 4.3% in 2014 (p < 0.001). The likelihood to receive non-enzyme-inducing antiepileptic drugs was 5.82 (95% CI 4.62-7.33) higher in 2014 than in 2008.Conclusion: Initial monotherapy for focal epilepsy is in line with current clinical practice guidelines and mainly implemented by prescription of levetiracetam. Further evaluations should address the question of whether patients treated in line with the guidelines have a favorable outcome, compared to patients not treated in line with current guidelines. (C) 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.