An analysis of Medicaid data showed that racial and ethnic minority groups were less likely to take new-generation antiepileptic drugs (ASMs) for epilepsy.
Compared with Caucasian patients, Black (adjusted OR 0.71, 95% CI 0.68-0.75), Hispanic (aOR 0.93, 95% CI 0.88-0.99), Native Hawaiian/Pacific Islander (aOR 0.77, 95% CI 0.67) -0.88) patients are unlikely to use a new ASM, report Wyatt Bensken, Ph.D., of Case Western Reserve University, Cleveland, and co-authors..
Of note, taking second-generation ASMs was associated with improved treatment adherence (aOR 1.17, 95% CI 1.11-1.23), with patients presenting to neurologists using newer ASMs. higher probability (aOR 3.26, 95% CI 3.13-3.41). ),researcher Neurology clinical training.
“Using new, second- and third-generation ASMs may be important indicators of quality of care for patients with epilepsy,” Bensken and team wrote, noting that new ASMs It cites evidence that fewer side effects are associated with more effective seizure control. .
“From the patterns we observed, a significant proportion of patients with epilepsy may not receive optimal ASM regimens, and the differences reflect apparent racial and ethnic inequalities in epilepsy care. It looks like,” they added.
Supplemental analyzes showed that a slightly higher proportion of black patients had seen a neurologist compared with white patients, but the study found that regardless of whether they did see a neurologist, Both blacks and Hispanics were less likely to use the new ASM.
New generation ASM use was more likely among newly diagnosed patients (aOR 1.29, 95% CI 1.16-1.42), females, younger patients, and frequent users.
“Even after adjusting for these generational inequalities, racial/ethnic adherence differences persisted among Black, Asian, and Hispanic individuals. Adherence was low,” wrote Bensken and colleagues.
“This underscores that the factors that influence adherence are complex and vary greatly from patient to patient,” they continued. should be evaluated to better understand the causes of these differences.”
They said, “Adverse reactions may be more common in some people due to their genetic predisposition and ability to handle certain drugs.”
Bensken et al. point out that medical mistrust may also play a role in the low adherence rate. It has been shown that “for black patients, complaints and pain treatment are taken less seriously, and racial matching between patients and their healthcare providers influences communication and creates trust.”
said Nassim Zecavati, M.D., M.P.H., director of epilepsy at Children’s Hospital in Richmond, Virginia. MedPage Today “This study highlights the fact that significant barriers remain in accessing epilepsy care for people of color, and that even if they do arrive at our clinic, the drugs they are prescribed are usually It highlights the fact that it is an older generation drug with potentially greater side effects.”
“As professionals, we need to better understand how systemic racism and implicit bias affect the care of people with epilepsy,” added Zecavati, who was not involved in the study. “The first step in providing optimal patient care is recognizing our own biases and the biases inherent in our healthcare system. It shows the need for further research to better understand the disparities in and how to overcome them.”
For this study, Bensken and team used Medicaid claims data from 78,534 adults (56.9% women) with epilepsy from 2010 to 2014. Just over half were white, 22.6% black, 11.9% Hispanic, and 1.5% Native Hawaiian/Pacific Islander.
Overall, 25.6% were using older 1st generation ASMs, 65.1% were using 2nd generation ASMs, and 9.3% were using 3rd generation ASMs.
Bensken et al. noted that their analysis lacked data on treatment-naïve patients and could not determine why patients used or switched to ASM.
This study was funded by the CDC and the National Institute on Minority Health and Health Disparities.
Bensken said he received support for the study from the National Minority Institute for Health and Health Disparities and is serving on the journal’s editorial board. neurology.
The co-authors also revealed multiple ties to the industry.
Neurology clinical practice
Source: Bensken WP, et al. Racial and Ethnic Differences in Antiepileptic Drugs in Medicaid Epilepsy Patients: A Case of Potential Inequity. Neurology 2023; DOI: 10.1212/CPJ.0000000000200101.