American adults who have epilepsy and are Black or Hispanic are less likely than white adults to be prescribed the latest medications, according to new research.
“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,” said study author Wyatt Bensken, a health disparities investigator at Case Western Reserve University in Cleveland, Ohio.
“These results show that a sizeable proportion of people may not be on an optimal treatment regimen, and the differences appear to reflect clear racial and ethnic inequities in care,” Bensken added.
The researchers studied the issue using Medicaid data for adults in 15 states who filled at least two prescriptions for epilepsy drugs from 2010 to 2014.
This included more than 78,000 adults, including 17,700 Black people, more than 9,300 of Hispanic origin and more than 1,100 who were Native Hawaiians or Pacific Islanders.
The data showed that 26% were on older, first-generation drugs such as carbamazepine, phenytoin and valproic acid. Another 65% were on newer, second-generation drugs such as gabapentin, lamotrigine, levetiracetam and zonisamide. In all, 9% were on even newer, third-generation drugs such as lacosamide and perampanel.
The investigators found that, overall, 66% of white people were prescribed second-generation drugs compared to 64% of Black and Hispanic patients, and 56% of Native Hawaiian and other Pacific Islander patients.
About 11% of white patients had prescriptions for third-generation drugs compared to 10% of those who were Hispanic or Native Hawaiians/Pacific Islanders and 6% of Black people, according to the report published online Jan. 11 in Neurology Clinical Practice.
People who saw a neurologist for their care were more likely to be prescribed the newer drugs than those who did not see a neurologist, the study found.
Researchers then adjusted for other factors, such as severity of epilepsy or having other health conditions or injuries that could affect prescription choices. They found that Black people still had 29% lower odds of being prescribed newer drugs than white people, while Native Hawaiian/Pacific Islander people had 23% lower odds and Hispanic people had 7% lower odds.
The study also found that people who were taking only second-generation drugs were more likely to take all their medication as prescribed.
“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 in a news release from the American Academy of Neurology.
“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 people take all their doses,” he suggested.
People untreated for their epilepsy were not included in the study, a key limitation. Assessing who remains untreated may uncover even greater inequities in care, the study authors noted.
The study was supported by the U.S. Centers for Disease Control and Prevention and the National Institute on Minority Health and Health Disparities of the National Institutes of Health.
The U.S. Centers for Disease Control and Prevention has more on epilepsy.
SOURCE: American Academy of Neurology, news release, Jan. 11, 2023