Patients with epilepsy of color, including Black, Hispanic, Native Hawaiian, and other Pacific Islander patients, are significantly more likely to be prescribed modern antiepileptic drugs (ASMs) than white patients. A new study shows that it is low.
Even after adjusting for epilepsy severity, comorbidities, and other factors that may influence drug choice, the researchers found that new drug use was 29% higher in black patients than in Native Hawaiians and other Pacific populations. We found 23% and 7% less in Islander patients. It may be seen in Hispanic patients compared to Caucasians.
Dr. Wyatt Bensken
“We hope our findings will help clinicians understand that a minority of patients with epilepsy face myriad barriers to receiving the highest quality care, including the use of ASM. Scientists at Case Western Reserve University in Cleveland, Ohio, said: Medscape Medical News“Considering patient barriers and how they affect patient care, including ASM selection, is critical to reducing these population-level inequities.”
The study was published online on January 11 neurology.
Custom Change Prompt
In this study, researchers used Medicaid claims for more than 78,000 people who had at least two prescriptions for ASM between 2010 and 2014.
Most patients were Caucasian (53.4%). 22.6% were black. 11.9% were Hispanic. 1.6% were Asian. 1.5% were native Hawaiians or other Pacific Islanders. 0.6% American Indian or Alaska Native. 8.3% were classified as “Other”.
A quarter of the participants were taking older ASMs such as carbamazepine, phenytoin and valproic acid. About 65% were taking second-generation ASMs such as gabapentin, levetiracetam, and zonisamide. Fewer than 10% were taking lacosamide, perampanel, or another third-generation ASM.
Compared with white patients, black patients were significantly less likely to be prescribed a newer drug (adjusted odds ratio [aOR]0.71; 95% CI, 0.68 – 0.75), native Hawaiian or other Pacific Islander (aOR, 0.77; 95% CI, 0.67 – 0.88), and Hispanic patients (aOR, 0.93; 95% CI, 0.88 – 0.99) .
Third-generation ASMs were used in 10.7% of Caucasian patients, 6% of Black patients, and 5.1% of Native American or Alaska Native patients.
The researchers also found that taking second-generation ASMs was associated with better treatment adherence (aOR, 1.17; 95% CI, 1.11–1.23), and that patients taking newer ASMs were more likely to be neurologists were also more than three times as likely to receive care. (aOR, 3.26; 95% CI, 3.13–3.41).
According to Bensken, the findings highlight racial inequalities around access to medicines and specialists and sub-specialists. he added that it is a sensible goal.
“In the meantime, we hope that raising awareness of these inequalities will encourage change across practices,” Bensken said.
“morning Call”
Comments on survey results Medscape Medical NewsJoseph Sirven, M.D., Ph.D., professor of neurology at the Mayo Clinic Florida in Jacksonville, said the results were “impressive” because the new ASM is generally the go-to for most physicians treating epilepsy. says.
“When we run out of options, we typically reserve the use of first-generation ASM,” says Sirven.
This study and others like it should serve as a “wake-up call” for clinicians, Sirven added.
“This study is important because it shows that race and ethnicity play a role in ASM, whether we are aware of it or not, and that this is related to economic access to a new generation of medicines. because there is,’ he said. “Similar findings are seen in poorer countries where first-generation his ASM drugs are routinely used because of drug prices.”
Explore more
also comment on Medscape Medical NewsUsing first-generation ASMs as a surrogate for quality of care is a “very innovative concept,” said Scott Mintzer, MD, professor and director of the Epilepsy Surveillance Unit at Thomas Jefferson University in Philadelphia. I said yes.
“From that perspective, the finding that racial minority patients are more likely to be on first-generation drugs is not surprising. But then interpretation becomes much more complicated.” he added.
Mintzer said both adherence and care by neurologists differed in consistent ways within various ethnic minority groups. Additionally, black patients were just as likely to see a neurologist as white patients, but were even more likely to be on first-generation drugs.
The findings also have some caveats to consider, Mintzer added. First, the sample included only Medicaid recipients, approximately 35% of whom had comorbid psychosis. These and other characteristics of the study pool suggest that the participants are not representative of the entire US population. Yes, but not reflected in these findings.
“So I don’t think we can really say yet how to address this,” Mintzer said. There are many potential explanations, admitted by the authors themselves, for what could be, so there is much to investigate.”
This study was funded by the US Centers for Disease Control and Prevention and the National Institute for Minority Health and Health Disparities (NIMHD). Bensken has received support for this work from her NIMHD and serves on the journal’s editorial board. neurologySirven and Mintzer have not reported any related financial relationships.
Neurology. Published online on January 11, 2023.full text
Kelli Whitlock Burton is a Medscape Medical News reporter covering neurology and psychiatry.
For more Medscape Neurology news, visit Facebook When twitter
