Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations

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dc.contributor.author Kinney, Michael O.
dc.contributor.author Morrow, James
dc.contributor.author Patterson, Chris C.
dc.contributor.author Campbell, Ellen
dc.contributor.author Russell, Aline
dc.contributor.author Smithson, W. Henry
dc.contributor.author Parsons, Linda
dc.contributor.author Morrison, Patrick J.
dc.contributor.author Bromley, Rebecca
dc.contributor.author Liggan, Brenda
dc.contributor.author Delanty, Norman
dc.contributor.author Irwin, Beth
dc.contributor.author Hunt, Stephen J.
dc.contributor.author Craig, John J.
dc.date.accessioned 2018-07-03T08:50:11Z
dc.date.available 2018-07-03T08:50:11Z
dc.date.issued 2018-04-16
dc.identifier.citation Kinney, M. O., Morrow, J., Patterson, C.C., Campbell, E., Russell, A., Smithson, W. H., Parsons, L., Morrison, P. J., Bromley, R., Liggan, B., Delanty, N., Irwin, B., Hunt, S. J. and Craig, J. J. (2018) 'Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations', Journal of Neurology, Neuroscience and Psychiatry. doi:10.1136/jnnp-2017-317368 en
dc.identifier.issn 0022-3050
dc.identifier.uri http://hdl.handle.net/10468/6404
dc.identifier.doi 10.1136/jnnp-2017-317368
dc.description.abstract Objectives: After 20 years of data collection, pregnancy registers have informed prescribing practice. Various populations show trends for a reduction in valproate prescribing, which is associated with an increased risk of anatomical teratogenesis and neurodevelopmental effects in those exposed in utero. Our aim was to determine if any shifts in prescribing trends have occurred in the UK and Ireland Epilepsy and Pregnancy Register cohort and to assess if there had been any change in the overall major congenital malformation (MCM) rate over time. Methods: The UK and Ireland Epilepsy and Pregnancy Register, a prospective, observational, registration and follow-up study established in 1996, was used to determine the changes in antiepileptic drugs (AEDs) utilised during pregnancy and the MCM rate between 1996 and 2016. Linear regression analysis was used to assess changes in AED utilisation, and Poisson regression was used for the analysis of trends in the MCM rates. Results: Outcome data for 9247 pregnancies showed a stable percentage of monotherapy to polytherapy prescribing habits over time. After Bonferroni correction, statistically significant (p<0.003) changes were found in monotherapy prescribing with increases in lamotrigine and levetiracetam and decreases in valproate and carbamazepine use. Between 1996 and 2016, the total MCM rate showed a 2.1% reduction per year (incidence risk ratio 0.979 (95% CIs 0.956 to 1.002) but Poisson regression analysis showed that this was not statistically significant p=0.08). Conclusion: Significant changes are seen in the prescribing habits in this cohort over 20 years, but a statistically significant change in the MCM rate was not detected. This work should be replicated on a larger scale to determine if significant changes are occurring in the MCM rate, which would allow a robust economic estimate of the benefits of improvements in prescribing practice and the personal effect of such changes. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group Ltd en
dc.rights © 2018, Article authors (or their employer(s) unless otherwise stated in the text of the article). This article has been accepted for publication in Journal of Neurology, Neuroscience and Psychiatry, 2018, following peer review, and the Version of Record can be accessed online at https://dx.doi.org/ 10.1136/jnnp-2017-317368. Reuse of this manuscript version is permitted strictly pursuant to the terms of the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Major congenital malformation en
dc.subject Valproate prescribing en
dc.subject In utero en
dc.subject AED en
dc.subject Anatomical teratogenesis en
dc.subject Neurodevelopmental effects en
dc.title Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother William Henry Smithson, General Practice, University College Cork, Cork, Ireland. +353-21-490-3000 Email: henry.smithson@ucc.ie en
dc.internal.availability Full text available en
dc.date.updated 2018-07-03T08:31:06Z
dc.description.version Accepted Version en
dc.internal.rssid 443941616
dc.description.status Peer reviewed en
dc.identifier.journaltitle Journal of Neurology, Neuroscience and Psychiatry en
dc.internal.copyrightchecked Yes en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress henry.smithson@ucc.ie en
dc.internal.bibliocheck In press. Check for vol. / issue / page numbers. Amend citation as necessary.


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© 2018, Article authors (or their employer(s) unless otherwise stated in the text of the article). This article has been accepted for publication in Journal of Neurology, Neuroscience and Psychiatry, 2018, following peer review, and the Version of Record can be accessed online at https://dx.doi.org/ 10.1136/jnnp-2017-317368. Reuse of this manuscript version is permitted strictly pursuant to the terms of the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ Except where otherwise noted, this item's license is described as © 2018, Article authors (or their employer(s) unless otherwise stated in the text of the article). This article has been accepted for publication in Journal of Neurology, Neuroscience and Psychiatry, 2018, following peer review, and the Version of Record can be accessed online at https://dx.doi.org/ 10.1136/jnnp-2017-317368. Reuse of this manuscript version is permitted strictly pursuant to the terms of the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
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