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Medication Utilization Patterns 90 Days Before Initiation of Treatment with Repository Corticotropin Injection in Patients with Infantile Spasms

Authors Gold LS, Nazareth TA, Yu TC, Fry KR, Mahler NH, Rava A, Waltrip II RW, Hansen RN

Received 5 July 2019

Accepted for publication 6 December 2019

Published 3 January 2020 Volume 2019:10 Pages 195—207

DOI https://doi.org/10.2147/PHMT.S222010

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Roosy Aulakh


Laura S Gold,1,2 Tara A Nazareth,3 Tzy-Chyi Yu,3 Keith R Fry,3 Nancy Ho Mahler,3 Andrew Rava,3 Royce W Waltrip II,3 Ryan N Hansen2,4

1Department of Radiology, University of Washington, Seattle, WA, USA; 2CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA; 3Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA; 4Department of Health Services, University of Washington, Seattle, WA, USA

Correspondence: Laura S Gold
Department of Radiology, University of Washington, Box 359558, Seattle, WA 98195-9558, USA
Tel +1 206-543-2749
Fax +1 206-543-8609
Email goldl@uw.edu

Introduction: Infantile spasms (IS) is a rare and devastating form of early childhood epilepsy. Two drugs are approved in the United States for treatment of IS, H.P. Acthar® Gel (repository corticotropin injection, RCI) and Sabril® (vigabatrin). Given real-world variation in treatment of patients with IS, this study characterized treatment patterns with IS medications and determined all-cause health care resource utilization (HCRU) during the 90 days before initiating therapy with RCI in patients with IS.
Materials and methods: Truven Health MarketScan® Research Databases were used to identify commercially insured US patients <2 years of age at RCI initiation with an IS diagnosis, per label use, from 1/1/07 to 12/31/15; presence of an electroencephalogram following diagnosis was required to assure diagnosis. Diagnosis codes and dispensed IS treatments of interest (drug classes including corticosteroids, vigabatrin, and other antiepileptic drugs [AEDs] excluding vigabatrin) before RCI initiation were evaluated.
Results: The 5 most common diagnoses other than IS observed in the study cohort (n=422) were “other convulsions,” “acute upper respiratory infection,” “esophageal reflux,” “epilepsy, unspecified,” and “abnormal involuntary muscle movements.” Among the study cohort, 51.7% received RCI first; 38.9% received 1 drug class and 9.5% received >1 drug class before RCI initiation. Other AEDs were dispensed most often, either alone (31.3%) or with other drug classes (9.3%). Mean HCRU included 11.8 all-cause outpatient visits and 4.5 medications dispensed. Patients who received RCI or corticosteroids as their initial IS treatment had the lowest and second-lowest HCRU.
Conclusion: In the 90 days before initiating RCI, patients with IS received multiple diagnoses and treatments, characterized by frequent HCRU. Use of RCI first (no prior IS medications) and AEDs first were associated with the lowest and highest HCRU, respectively, across all categories (all-cause outpatient visits, emergency department visits, hospital admissions, prescription medications).

Keywords: Infantile spasms, early diagnosis, early treatment, health care resource utilization, medication patterns


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