Therapy outcomes associated with prescription cannabidiol use at 12 months post-initiation

Kayla Johnson; Jessica P Barnes; Holly Dial; Josh DeClercq; Leena Choi; Nisha B Shah; Shilpa Reddy; Autumn D Zuckerman

doi:10.1016/j.yebeh.2023.109412

Therapy outcomes associated with prescription cannabidiol use at 12 months post-initiation

Epilepsy Behav. 2023 Oct:147:109412. doi: 10.1016/j.yebeh.2023.109412. Epub 2023 Sep 2.

Authors

Kayla Johnson¹, Jessica P Barnes², Holly Dial³, Josh DeClercq⁴, Leena Choi⁵, Nisha B Shah⁶, Shilpa Reddy⁷, Autumn D Zuckerman⁸

Affiliations

¹ Vanderbilt Specialty Pharmacy, Vanderbilt Health System, 1211 Medical Center Dr, Nashville, TN 37232, USA. Electronic address: kayla.d.johnson@vumc.org.
² Lipscomb University College of Pharmacy, 1 University Park Dr, Nashville, TN 37204, USA. Electronic address: jpbarnes123@comcast.net.
³ Lipscomb University College of Pharmacy, 1 University Park Dr, Nashville, TN 37204, USA. Electronic address: holly.owens@ascension.org.
⁴ Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA. Electronic address: josh.declercq@vumc.org.
⁵ Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA. Electronic address: leena.choi@vumc.org.
⁶ Vanderbilt Specialty Pharmacy, Vanderbilt Health System, 1211 Medical Center Dr, Nashville, TN 37232, USA. Electronic address: norahj.pharmd@icloud.com.
⁷ Department of Pediatric Neurology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA. Electronic address: shilpa.b.reddy@vumc.org.
⁸ Vanderbilt Specialty Pharmacy, Vanderbilt Health System, 1211 Medical Center Dr, Nashville, TN 37232, USA. Electronic address: autumn.zuckerman@vumc.org.

PMID: 37666204
DOI: 10.1016/j.yebeh.2023.109412

Abstract

Objective: This study evaluated prescription cannabidiol (CBD) outcomes during the first 12 months of therapy.

Methods: A single-center, prospective cohort study was performed including patients prescribed CBD from January 2019 - April 2020, excluding clinical trial patients and those using external specialty pharmacy services. The primary outcome wasepilepsy-related emergency healthcare service (EHS) use within 12 months of initation. Secondary outcomes included prescription CBD discontinuation rate and reason and concomitant anti-seizure medication (ASM) use. A multiple logistic regression model evaluated the odds of EHS use, adjusting for initial concomitant ASM count, age, and insurance type.

Results: The 136 patients included were 85% white, 50% female, and 68% pediatric. EHS utilization occurred in 37% (n = 50) of patients; 29 patients (21%, n = 20 pediatric, n = 9 adult) had at least one emergency department (ED) visit, 9 patients (7%) had two or more; 30 patients (22%, n = 22 pediatric, n = 8 adult) had at least one hospitalizaion. Median time to first ED and hospitalization was 69 (IQR 31-196) and 104 (IQR 38-179) days, respectively. Prescription CBD was discontinued in 31 patients (23%, n = 18 pediatric, n = 13 adult), due to major side effects (n = 12, 39%), common side effects (n = 11, 36%), and unsatisfactory response (n = 11, 36%). There was no significant change in concomitant ASM use.

Conclusion: Despite potential benefits of prescription CBD, many patients utilize EHSs in the first 12 months of treatment with minimal changes in concomitant ASM use.

Keywords: Antiseizure medication (ASM); Cannabidiol (CBD); Emergency healthcare use; Epilepsy; Persistence.