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Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records

Caroline E Dale Orcid Logo, Rohan Takhar, Yat Yi Fan, Fatemeh Torabi Orcid Logo, Michail Katsoulis, Samuel Kim, Andrew Lambarth, Christopher Tomlinson Orcid Logo, Tim Wilkinson Orcid Logo, Tanja Mueller Orcid Logo, Amanj Kurdi Orcid Logo, Mark Ashworth, Mamas A Mamas, Kamlesh Khunti, Ashley Akbari Orcid Logo, Andrew D Morris, Munir Pirmohamed Orcid Logo, Anthony G Marson, David Williams Orcid Logo, David Hunt, Cathie Sudlow Orcid Logo, Reecha Sofat

BMJ Medicine, Volume: 3, Issue: 1, Start page: e000760

Swansea University Authors: Fatemeh Torabi Orcid Logo, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1136/bmjmed-2023-000760

Abstract

Objective To investigate the use of sodium valproate in England and Wales, including during pregnancy, compared with other antiseizure drug treatments, based on national level electronic health records.Design Quantitative analysis of nationwide linked electronic health records.Setting Individual lev...

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Published in: BMJ Medicine
ISSN: 2754-0413
Published: BMJ 2024
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa68622
Abstract: Objective To investigate the use of sodium valproate in England and Wales, including during pregnancy, compared with other antiseizure drug treatments, based on national level electronic health records.Design Quantitative analysis of nationwide linked electronic health records.Setting Individual level, population scale data from NHS England's Secure Data Environment, from the British Heart Foundation Data Science Centre's CVD-COVID-UK/COVID-IMPACT Consortium (for England), and the Secure Anonymised Information Linkage Databank (for Wales), 1 January 2019 to 31 December 2023.Participants 1 200 000 individuals dispensed any selected antiseizure drug treatment (ie, sodium valproate, lamotrigine, levetiracetam, carbamazepine, or topiramate); 304 000 women, aged 15-49 years, dispensed any selected antiseizure drug treatment and 28 400 women, aged 15-49 years, dispensed sodium valproate.Main outcome measures Prevalent (current) and incident (new) uses of sodium valproate and other antiseizure drug treatments before and during the covid-19 pandemic (1 January 2019 to 31 December 2023), grouped by age and sex. Pregnancy rates per 1000 women, aged 15-49 years, who used antiseizure drug treatments, and timing and dose of sodium valproate dispensed during pregnancy. Geographical variation in use of sodium valproate and disease indications (epilepsy and bipolar affective disorder). Trends in deaths related to epilepsy for 2015-22.Results Prevalent use of sodium valproate in women of childbearing potential decreased and use of most other antiseizure drug treatments increased between 2019 and 2023. Incident use of sodium valproate per 100 000 women decreased from seven to five in women aged 15-19 years, from 11 to seven in women aged 20-29 years, and from 14 to seven in women aged 30-39 years between 2019 and 2022. Incident use also decreased in men of the same age but remained at much higher levels (from 53 to 43 in men aged 15-19 years, 59 to 47 in men aged 20-29 years, and 57 to 42 in men aged 30-39 years, per 100 000 men). Pregnancy rates decreased from 6.0 to 5.2 per 1000 women of childbearing potential who were dispensed sodium valproate over the same period. The number of pregnant women who used sodium valproate during pregnancy decreased from 140 in 2019 to 85 in 2023. Epilepsy was the most common indication, followed by bipolar affective disorder (751 and 193 per 1000 women of childbearing potential dispensed sodium valproate, respectively, in 2023). No clear evidence was found that deaths related to epilepsy increased in women aged 15-49 during 2015-22, but a slight increase was found in men aged 15-49 during the later period between April 2018 and December 2022.Conclusions Based on comprehensive national records, changes in the dispensing of antiseizure drug treatments in response to regulatory actions were tracked. Rates for use of sodium valproate by women, including during pregnancy, decreased before and continued to slowly decrease during the covid-19 pandemic. Incident use was also reduced in men but remained at much higher levels than in women. This approach, linking national dispensing data to health records at the individual level, could help monitor changes to medicines affected by regulatory changes, including in specific population groups, such as pregnant individuals, and their potential effect on health outcomes.
College: Faculty of Medicine, Health and Life Sciences
Funders: The British Heart Foundation (BHF) Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co- development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser’s National Core Studies programme to coordinate national covid- 19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This research is part of the Data and Connectivity National Core Study, led by HDR UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant No MC_PC_20058). This work was also supported by the Alan Turing Institute through ‘Towards Turing 2.0’ Engineering and Physical Sciences Research Council (EPSRC) grant funding. This work was supported by the Con- COV team funded by the Medical Research Council (grant No MR/ V028367/1). This work was supported by HDR UK, which receives its funding from HDR UK (HDR- 9006) funded by the UK Medical Research Council, EPSRC, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), BHF, and the Wellcome Trust. This research has been supported by the Administrative Data Research (ADR) Wales programme of work. ADR Wales, part of the ADR UK investment, unites research expertise from Swansea University Medical School and WISERD (Wales Institute of Social and Economic Research and Data) at Cardiff University with analysts from the Welsh Government. ADR UK is funded by the Economic and Social Research Council (ESRC), part of UK Research and Innovation. This research was supported by ESRC funding, including ADR Wales (ES/W012227/1). This work was supported by the Wales covid- 19 Evidence Centre, funded by Health and Care Research Wales. RS, research professorship, NIHR303160, is funded by the National Institute for Health and Care Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. DH is supported by the Wellcome Trust (215621/Z/19/Z) and the Medical Research Foundation. AL holds an NIHR funded academic clinical fellowship. FT is funded by HDR UK. CT is supported by a University College London (UCL) UK Research and nnovation (UKRI) Centre for Doctoral Training in artificial intelligence enabled healthcare studentship (EP/S021612/1), MRC Clinical Top- Up, and a studentship from the NIHR Biomedical Research Centre at UCL Hospital NHS Trust. AGM is a NIHR senior investigator and also part funded by NIHR Applied Research Collaboration (ARC) North West Coast.
Issue: 1
Start Page: e000760

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