Inequities were also apparent between those who saw and did not see neurologists, analysis shows.
Individuals who are Black, Hispanic, Native Hawaiian, and other Pacific islanders with epilepsy are less likely to be prescribed newer drugs than individuals who are White, according to the results of a study published in Neurology Clinical Practice.
Investigators also found that individuals who saw neurologists for their care were more likely to be prescribed newer drugs than those who did not see neurologists.
“While finding the right medication is often a trial-and-error process that is based on the individual, studies have shown that use of newer medications improves outcomes, and some newer medications have fewer side effects,” Wyatt Bensken, PhD, of Case Western Reserve University in Cleveland, Ohio, said in a statement. “These results show that a sizeable proportion of [individuals] may not be on an optimal treatment regimen, and the differences appear to reflect clear racial and ethnic inequities in care.”
Medicaid data for individuals who filled at least 2 prescriptions for epilepsy drugs were collected between 2010 and 2014 in 15 states. Investigators included 78,534 individuals with epilepsy, including 17,729 individuals who are Black, 9376 who are Hispanic, and 1154 who are Native Hawaiian and other Pacific islanders.
A total of 26% of individuals were on first-generation drugs, including carbamazepine, phenytoin, and valproic acid. Additionally, 65% were on second-generation drugs, including gabapentin, lamotrigine, levetiracetam, and zonisamide.
Just 9% were on third-generation drugs, including lacosamide and perampanel.
Investigators found that 66% of individuals who are White were prescribed second-generation drugs compared with 64% who are Black or Hispanic and 56% of those who are Native Hawaiian or other Pacific islanders.
Furthermore, 11% of White individuals and 10% of Hispanic and Native Hawaiian and other Pacific Islander individuals and 6% of Black individuals were on third-generation drugs.
Individuals adjusted for other factors which could affect what drug an individual was prescribed, including health conditions, injuries, and the severity of the epilepsy. They found that approximately 29% of Black individuals had lower odds of being prescribed newer drugs than individuals who are White, while Native Hawaiian individuals and other Pacific islanders had 23% lower odds, and individuals who were Latino had 7% lower odds.
“While further study is needed to understand these differences and the mechanisms behind them, these critical gaps in care may represent disparities that can be addressed and that warrant greater attention,” Bensken said. “Changes that could be made include increasing referrals to neurologists and exploring whether a newer drug may be as effective as an older drug but with fewer side effects, which could increase the likelihood that [individuals] take all their doses.”
Further, individuals who saw neurologists for their care had 3 times the odds of being prescribed newer drugs than those who did not see neurologists. Individuals who were taking only second-generation drugs were also more likely to take all their medication as prescribed.
Investigators cited a limitation of the study as individuals with epilepsy were identified as those who filled at least 2 prescriptions for epilepsy drugs, excluding those who were untreated.
Black, Latino people with epilepsy less likely to be prescribed newer drugs. EurekAlert. News release. January 11, 2023. Accessed January 17, 2023. https://www.eurekalert.org/news-releases/975817