Rosenow F, Winter Y, Leunikava I, Brunnert M, Sutphin J, Brandt C. Patient preference in epilepsy monotherapy prior to physician consultation: real-world interim data from a multinational noninterventional study. Poster presented at the 2019 ILAE British Chapter meeting; October 2, 2019. Birmingham, United Kingdom.


PURPOSE: Patient-centred care, which considers individual patient preferences, needs, and values, is increasingly recognized in modern healthcare. Shared decision-making, by attempting to involve the patient and clinician equally in the decision-making process, is part of this evolution. Adverse events (AEs) affect many patients with epilepsy and few studies have evaluated the patient’s perspective on antiepileptic drugs (AEDs) and potential AEs. The objective of this study was to elicit patient’s preferences before physician consultation for a new AED monotherapy and explore the tradeoffs that patients are willing to make between efficacy and AEs.

METHODS:
An interim analysis of a prospective, observational study (EP0076) using a discrete choice experiment survey administered to patients from seven European countries: United Kingdom, Denmark, France, Germany, Spain, Italy, and Netherlands. Patients were presented with a series of twelve choices between two hypothetical treatments defined by seven features with three to four levels: chance of becoming seizure-free, chance of developing clinical depression, personality changes, trouble thinking clearly, dizziness, change in body weight in 6 months, and sleepiness or tiredness. The data were analyzed using a random-parameters logit model.

RESULTS: At the time of the interim analysis, 127 patients were enrolled in the study (Enrolled Set, ES) and 125 had completed the survey. The mean (SD) age was 48.2 (18.9) years, 57.4% of patients were aged >65 years and 51.2% were females. The mean (SD) epilepsy duration was 12.9 (14.7) years and the median (range) focal seizure frequency per 28 days was 2.8 (0-112; ES). 37% of patients had discontinued >2 AEDs. Most common reasons for changing current AED regime were insufficient efficacy (47.2%) and adverse drug reaction (35.4%). Preference weights were ordered as expected, with better outcomes being preferred to worse outcomes. Results suggest that the most important features were the chance of becoming seizure free and avoiding trouble thinking clearly. Avoiding personality changes, dizziness, sleepiness or tiredness, and developing clinical depression were equally important. Bodyweight change in 6 months was the least important. Patients were willing to accept increased AEs to obtain additional efficacy but required a higher chance of improvements in efficacy to accept more severe AEs.

CONCLUSIONS: These interim data from a prospective, observational study eliciting patient preferences for a new hypothetical AED monotherapy suggest that the most important features are seizure freedom and avoiding negative impact on cognition. Patients are willing to accept a risk of AEs for an increased chance of seizure freedom.

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