Epilepsy – Current Treatment – Detailed, Expanded Analysis (US)

Epilepsy is a heterogeneous condition requiring individualized treatment, based largely on a patient’s seizure syndrome and seizure type. Epilepsy patients also differ widely in their responses to treatment with antiepileptic drugs (AEDs) and often are treatment-refractory. As a result, neurologists must consider many factors when selecting among the numerous first-, second-, and third-generation AEDs currently available, and make adjustments—in dosing, or by adding and switching—throughout a patients’ disease course to achieve optimal seizure control. Understanding the many decision points neurologists face in the treatment of epilepsy provides important context about the complex market that developers of investigational AEDs will enter.

How is epilepsy being treated in the United States today, and what are the factors behind those treatment decisions? The Epilepsy Current Treatment Overview provides a synopsis of current treatment goals, key therapies, and medical practice in the G7 markets. The detailed, expanded analysis in Epilepsy Current Treatment (US) offers a snapshot of how U.S. neurologists are currently managing their epilepsy patients as well as insight into the factors driving such prescribing habits. This new Current Treatment offering provides deep insights, with real-world evidence wherever possible.

Table of contents

  • Epilepsy - Current Treatment - Detailed, Expanded Analysis (US)
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • The Epilepsy Population Is Diverse
        • Distribution of Healthcare Coverage Among Epilepsy Patients (Survey Data)
        • Age-Group Distribution Among Epilepsy Patients (Survey Data)
        • Age Distribution Among Epilepsy Patients (RWD: EHR)
        • Primary Seizure Phenotype Distribution Among Epilepsy Patients (Survey Data)
        • Seizure Syndrome Distribution Among Epilepsy Patients (Survey Data)
        • Percentage of Treatment-Refractory Epilepsy Patients (Survey Data)
        • Percentage of Epilepsy Patients Experiencing Acute Seizure Events/Emergencies (Survey Data)
      • Treatment Practices
        • AED Positioning in the Epilepsy Treatment Paradigm Is Stable but Can Vary by Seizure Phenotype and Syndrome
        • Most Epilepsy Patients Initiate Drug Therapy Soon After Diagnosis
        • Distribution of Average Time to Treatment Initiation Among Epilepsy Patients (Survey Data)
        • The Majority of Epilepsy Patients Are Drug-Treated
        • Treatment Rates for Epilepsy Patients by Seizure Phenotype/Syndrome (Survey Data)
        • Treatment Rate for Patients Diagnosed with Epilepsy (RWD: EHR)
        • Second-Generation AEDs Are the Patient-Share Leaders in Epilepsy
        • Patient Shares of Key AEDs Among Drug-Treated Epilepsy Patients (Survey Data)
        • Patient Share by Product Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Patient Share by Class Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Preferred AEDs by Epilepsy Seizure Syndrome (Survey Data)
        • Patient Shares of Key Acute Rescue Therapies Among Eligible Epilepsy Patients (Survey Data)
        • Quarter over Quarter Patient Share by Product Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Well-Established Generic AEDs with Proven Efficacy and Favorable Tolerability Experience the Longest Duration of Use
        • AEDs' Duration of Use Before Discontinuation (Survey Data)
        • Surgical and Stimulation Approaches Have a (Minor) Role in Epilepsy Treatment
        • Patient Shares of Pharmacological and Nonpharmacological Approaches Among Epilepsy Patients (Survey Data)
        • Levetiracetam and Lamotrigine Dominate Early Lines of Treatment While Use of Other AEDs Is More Fragmented
        • Nearly Half of Epilepsy Patients Are on Their First Line of Therapy
        • Line of Therapy Distribution Among Epilepsy Patients (Survey Data)
        • Epilepsy Patients Progress Steadily Through Lines of Therapy Until Seizure Suppression Is Achieved
        • Time to Progression by Line of Therapy Among Newly Diagnosed Epilepsy Patients Progressing Within a Year of Diagnosis (RWD: Claims)
        • Time to Progression by Line of Therapy Among Epilepsy Patients (Survey Data)
        • Average Number of Monotherapies Tried Before Initiating Combination Therapy by Seizure Phenotype/Syndrome (Survey Data)
        • Line of Therapy Progression in Epilepsy by Switches and Adds (Survey Data)
        • First- and Second-Generation AEDs Claim the Most Patient Share in Early Lines of Therapy
        • Patient Share of Key AEDs by Seizure Phenotype and Line of Therapy Among Drug-Treated Epilepsy Patients (Survey Data)
        • Preferred AEDs for Treatment-Refractory Epilepsy Patients by Seizure Phenotype (Survey Data)
        • Patient Share of AED Classes by Line of Therapy (RWD: Claims)
        • Quarter over Quarter Product Patient Share by First Line of Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Quarter over Quarter Product Patient Share by Second Line of Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Quarter over Quarter Product Patient Share by Third Line of Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Polypharmacy Is Common in Epilepsy Treatment
        • Distribution of Polypharmacy Rates Among Epilepsy Patients (Survey Data)
        • Drug Burden Distribution Among All Recently Treated Epilepsy Patients (RWD: Claims)
        • Drug Burden by Line of Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
      • Persistency and Compliance
        • Epilepsy Patients Are Generally Compliant and Persistent with Their AED Medication
        • Discontinuation Rates by AED Among Epilepsy Patients (Survey Data)
        • Persistency by AED Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Compliance Rates by AED Among Epilepsy Patients (Survey Data)
        • Compliance Rates by AED Among Recently Treated Epilepsy Patients (RWD: Claims)
      • Sequencing of Treatment
        • Treatment Sequencing Is Influenced by Patient Age and Seizure Phenotype
        • Comparison of Key Therapy Sources for AEDs Among Recently Treated Patients (RWD: Claims)
        • Preferred First-Line AEDs by Patient Age and Seizure Phenotype (Survey Data)
        • Clobazam Patient Flow in Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Clobazam Patient Flow Among Recently Treated Patients (RWD: Claims)
        • Lamotrigine Patient Flow in Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Lamotrigine Patient Flow in Recently Treated Epilepsy Patients (RWD: Claims)
        • Levetiracetam Patient Flow in Newly Diagnosed Patients (RWD: Claims)
        • Levetiracetam Patient Flow in Recently Treated Epilepsy Patients (RWD: Claims)
      • Recent/Anticipated Changes in Brand Use/Treatment Approach
        • Physicians' Use of Branded AEDs in Epilepsy Is Increasing
        • Changing Use of AEDs in the Past Year (Survey Data)
        • Current and Anticipated Brand Patient Shares by AED (Survey Data)
        • Current and Anticipated Brand Prescriber Bases by AED (Survey Data)
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Unsurprisingly, Seizure Suppression Is the Most Important Factor in the Prescribing Decision for Epilepsy
        • Treatment Selection in Epilepsy Is Influenced by Many Factors
        • Factors Influencing Treatment Selection in Epilepsy Patients by Age-Group (Survey Data)
        • Factors Influencing Treatment Selection in Epilepsy Patients by Seizure Phenotype (Survey Data)
        • Physician Perception of AED Classes (Survey Data)
        • Physician Opinion of Non-Clinical Prescribing Factors (Survey Data)
        • Efficacy Is, Understandably, a Strong Driver of AED Prescribing
        • Major Drivers of Nonbranded AED Use (Survey Data)
        • Major Drivers of Branded AED Use (Survey Data)
        • Physician Perception of the Clinical Value of Extended-Release Formulations (Survey Data)
        • Top AEDs for Which Extended-Release Formulations Have Added Value over Immediate-Release Formulations (Survey Data)
        • Patient Share of Nonsolid Oral Formulations of AEDs by Age-Group (Survey Data)
        • Cost and Coverage Are Key Obstacles to Use of Branded AEDs
        • Major Obstacles to Use of Branded AEDs (Survey Data)
        • Several Factors Determine Whether to Add a Therapy or Switch to a New Monotherapy
        • Factors Influencing the Decision Whether to Switch or Add in the Epilepsy Treatment Algorithm (Survey Data)
        • Factors Influencing Switching and Adding in the Epilepsy Treatment Algorithm (Survey Data)
        • Factors Influencing Adjunctive Prescribing Decisions Among Available AEDs (Survey Data)
        • Tolerability Issues and Lack of Efficacy Drive Discontinuations for Most AEDs
        • Common Reasons for Therapy Discontinuation by AED (Survey Data)
        • AED Initiation May Be Deferred by Patient Resistance, Among Other Factors
        • Common Reasons for Treatment Deferral (Survey Data)
        • Common Reasons for Deferral of Acute Rescue Treatment (Survey Data)
      • Face-to-Face Product Detailing Effectiveness
        • Brand Details Are Infrequent but Can Be Effective
        • Detailing Reach for AED Brands Is Limited
        • Sales Representative Access to Surveyed Neurologists (Survey Data)
        • Detailing Reach by Brand (Survey Data)
        • Detailing Frequency Within the Past Six Months by Brand (Survey Data)
        • Detailing Reach Within the Past Month by Brand (Survey Data)
        • Physician Satisfaction with Sales Representatives Is High for All Branded AEDs
        • Recently Detailed Neurologists' Satisfaction with Sales Representatives (Survey Data)
        • Messages Given During Brand Detailing Cover a Wide Range of Topics
        • Messages from Recent AED Brand Detailing (Survey Data)
    • Appendix
      • Primary Market Research
        • Current Patient Share of Topiramate Formulations Among Patients Currently Treated with Topiramate (Survey Data)
        • Monotherapy and Adjunct Use of Branded AEDs (Survey Data)
      • Real-World Data
        • Gender Distribution Among Epilepsy Patients (RWD: EHR)
        • Race Distribution Among Epilepsy Patients (RWD: EHR)
        • Body Mass Index Distribution Among Epilepsy Patients (RWD: EHR)
        • Treatment Duration of Preceding Therapy by Product Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Source of Business by Product Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use in First-Line Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use in Second-Line Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use in Third-Line Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Combination Therapies in First-Line Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Combination Therapies in Second-Line Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Combination Therapies in Third-Line Therapy Among Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Drug Progression Rates from First-Line Therapy Among Newly Diagnosed Epilepsy Patients Progressing Within a Year of Diagnosis (RWD: Claims)
        • Drug Progression Rates from Second-Line Therapy Among Newly Diagnosed Epilepsy Patients Progressing Within a Year of Diagnosis (RWD: Claims)
        • Ranges of Medication Possession Ratios Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Persistency Sample Sizes Among Recently Treated Epilepsy Patients (RWD: Claims)
        • Lacosamide Patient Flow in Newly Diagnosed Epilepsy Patients (RWD: Claims)
        • Lacosamide Patient Flow in Recently Treated Epilepsy Patients (RWD: Claims)