Increasing medication supply may prevent breakthrough seizures in veterans with epilepsy

Key takeaways:

• Allowing clinicians to prescribe a larger supply of antiseizure drugs to veterans with epilepsy improved adherence.
• Results of the study led to a policy change in one city and pending change in another.

LOS ANGELES — U.S. veterans with epilepsy were more likely to adhere to a 90-day supply of antiseizure medication vs. a 30-day supply, resulting in fewer breakthrough seizures and a successful policy change within the VA, researchers reported.

“The VA has a policy where it allows 90-day prescriptions for controlled substances, but the policy has to be approved locally,” Rebekah Kaska, MSN, from the VA Epilepsy Center of Excellence in Richmond, Virginia, told Healio at the American Epilepsy Society annual meeting. “There are several concerns in terms of patients with epilepsy not obtaining their medications on time, including possible death, so we take it very seriously.”

Kaska and colleagues sought to provide sufficient data to prove that long-term medication adherence is beneficial for U.S. veterans with epilepsy, as a method to enact necessary policy change and ensure their health and welfare.

They conducted a retrospective chart review of the center’s database in 2022. The analysis included 708 patients on antiseizure medications (ASMs) from three VA Epilepsy Centers of Excellence: Richmond (n =308), Houston (n = 252) and Los Angeles (n = 148).

The researchers calculated adherence rates to the 30- vs. 90-day supply and examined the number of breakthrough seizures, ED admissions due to seizure-related injuries and other mitigating factors in each group.

According to the results, the average proportion of days covered for ASMs with the 30-day supply was 85% in Houston and Los Angeles and 87% in Richmond. Meanwhile, the average proportion of days covered with the 90-day supply was 93% for all three locations.

Data further showed that the average days missed per year for ASMs with the 30-day supply were 48 in Richmond and 56 in both Houston and Los Angeles, compared with 25 each in Houston and Los Angeles and 26 in Richmond with the 90-day supply.

Kaska and colleagues reported that patients with the 90-day medication supply had fewer breakthrough seizures, ED admissions and seizure-related injuries compared with those who had a 30-day supply.

They noted that their findings assisted in a policy change at the VA’s Richmond location, where certain ASMs can be prescribed over 90 days with one refill. They added that the VA’s Houston location is currently developing a similar policy, with the Los Angeles location already demonstrating a 96% adherence rate for controlled ASMs in 2022.

“We can definitely still improve adherence,” Kaska told Healio. “We think that this will have an impact on patients’ lives and patient safety.”