Shift from older‐ to newer‐generation antiseizure medications in people with acute ischemic stroke in Australia: A population‐based study

OBJECTIVE: To investigate the trends in antiseizure medications (ASMs) use following ischemic stroke and to examine factors associated with use of newer‐ and older‐generation ASMs. METHODS: A retrospective cohort study was conducted using state‐wide linked health datasets. Patients who were hospitalized with a first‐ever ischemic stroke between 2013 and 2017 and were dispensed ASM within 12 months from discharge were included. Logistic regression was used to examine the predictors of receiving newer‐generation ASMs. Generalized linear modeling was used to identify factors associated with ASM use after ischemic stroke. RESULTS: Of 19 601 people hospitalized with a first‐ever ischemic stroke, 989 were dispensed an ASM within 12 months from discharge. The most prevalent first ASMs were levetiracetam (38.0%), valproate (25.8%), and carbamazepine (10.3%). Most people were dispensed ASM monotherapy (86.9%). There was a shift toward the use of newer‐generation ASMs between 2013 and 2017 (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.92–4.16). Metropolitan residents were more likely to be dispensed newer‐generation ASMs as a first‐line treatment (OR 1.79, 95% CI 1.31–2.45). People over 85 years (OR 0.38, 95% CI 0.23–0.64), with dementia (OR 0.35, 95% CI 0.19–0.63) and psychotic comorbidities (OR 0.29, 95% CI 0.09–0.96) were less likely to be dispensed newer‐generation ASMs. Older age (coefficient [β] 0.23, P = 0.030), history of beta blocker use (β 0.17, P = 0.029), multiple ASMs (β 0.78, P < 0.001), and newer‐generation ASM (β 0.23, P = 0.001) were associated with higher defined daily dose (DDD) of ASM whereas female sex and being married were associated with lower DDD. SIGNIFICANCE: There has been a shift toward newer‐generation ASMs for poststroke seizures and epilepsy. Concerningly, vulnerable patient groups were more likely to be dispensed older‐generation ASMs. This may lead to unnecessary exposure to adverse events and drug–drug interactions. Further research is needed to evaluate comparative effectiveness and safety of newer‐ and older‐generation ASMs in poststroke populations.