April 16, 2019
According to recent study findings, older adults with epilepsy who are taking antiepileptic drugs are at an increased risk of falls.
“Falls are the most common cause of fatal and non-fatal injuries and hospital admissions for trauma in the elderly,” said lead study author Eugene Kreys, PharmD, PhD, BCPS, and colleagues. “Numerous studies demonstrated an increased fall risk related to antiepileptic drug treatment.”
In order to compared the association between antiepileptic drugs and fall risks that require hospitalizations among older adults, Dr Kreys and his colleagues conducted a nested, case-controlled study.
“Patients with an inpatient admission for fall were matched to controls, those admitted for a diagnosis aside from fall, fracture, or trauma, in a 1:3 ratio based on age, sex, and osteoporosis diagnosis,” the researcher team explained. “Initially, the increased fall risk with antiepileptics was reestablished by comparing the odds of filling a prescription for an antiepileptic prior to admission, based on Part D claims data, to the controls. To compare fall risk among antiepileptics, a second cohort, limited only to patients receiving antiepileptics, was subsequently re-matched in a 1:1 ratio based on the same characteristics.”
The first study cohort consisted of 15,345 cases and 46,035 controls. Further, the average age was 77.9±8.6 years, 63.3% were female, and 27.1% had osteoporosis. The second cohort consisted of 197 cases and 197 controls.
According to the findings, 54% of cases in the first cohort were diagnosed with a fracture or trauma—the most commonly seen include femur fracture and traumatic brain injury. Among patients in the first cohort, antiepileptics were also associated with a higher fall risk with an odds ratio of 3.24.
Among the second cohort, the research team found that a combination of two or more antiepileptic drugs accounted for 27.2% of all antiepileptic use, followed by gabapentin monotherapy (23.9%), and levetiracetam monotherapy (15.7%). Additionally, phenytoin, levetiracetam, and gabapentin were the most common medications used in combination treatment. Dr Kreys and his colleagues found that as compared to gabapentin, fall risk was higher for those receiving carbamazepine, levetiracetam, phenytoin, and combination treatment.
“Antiepileptic use in the elderly with epilepsy was associated with an increased fall risk,” Dr Kreys and colleagues concluded. “Carbamazepine, levetiracetam, phenytoin, and combination antiepileptic treatment was found to increase fall risk relative to gabapentin.”
Kreys E, Clark S, Kreys T, Comparing Fall Risk Among Antiepileptic Drugs in the Elderly: A Nested, Case-Control Study of a Medicare Database [G46]. J Manag Care Spec Pharm. 2019;25(3-a). https://www.jmcp.org/doi/pdf/10.18553/jmcp.2019.25.3-a.s1