Shift from older‐ to newer‐generation antiseizure medications in people with acute ischemic stroke in Australia: A population‐based study

Abstract

ObjectiveTo investigate the trends in antiseizure medications (ASM) use following ischaemic stroke and to examine factors associated with use of newer‐ and older‐generation ASMs.MethodsA retrospective cohort study was conducted using state‐wide linked health datasets. Patients who were hospitalised with a first‐ever ischaemic stroke between 2013‐2017 and were dispensed ASM within 12 months from discharge were included. Logistic regression was used to examine the predictors of receiving newer‐generation ASMs. Generalised linear modelling was used to identify factors associated with ASM use after ischaemic stroke.ResultsOf 19,601 people hospitalized with a first‐ever ischaemic stroke, 989 were dispensed an ASM within 12 months from discharge. The most prevalent first ASMs were levetiracetam (38.0%), valproate (25.8%) and carbamazepine (10.3%). Most people were dispensed ASM monotherapy (86.9%). There was a shift towards the use of newer‐generation ASMs between 2013‐2017 (Odds Ratio [OR] 2.82, 95% confidence interval [CI] 1.92‐4.16). Metropolitan residents were more likely to be dispensed newer‐generation ASMs as a first‐line treatment (OR 1.79, 95% CI 1.31‐2.45). People over 85 years (OR 0.38, 95% CI 0.23‐0.64), with dementia (OR 0.35, 95% CI 0.19‐0.63) and psychotic comorbidities (OR 0.29, 95% CI 0.09‐0.96) were less likely to be dispensed newer‐generation ASMs. Older age (coefficient [β] 0.23, p=0.030), history of beta blocker use (β 0.17, p=0.029), multiple ASMs (β 0.78, p<0.001) and newer‐generation ASM (β 0.23, p=0.001) were associated with higher defined daily dose (DDD) of ASM whereas female sex and being married were associated with lower DDD.SignificanceThere has been a shift toward newer‐generation ASMs for post‐stroke seizures and epilepsy. Concerningly, vulnerable patient groups were more likely to be dispensed older‐generation ASMs. This may lead to unnecessary exposure to adverse events and drug‐drug interactions. Further research is needed to evaluate comparative effectiveness and safety of newer‐ and older‐generation ASMs in post‐stroke populations.