# Trends in paediatric antiseizure-medication use and costs in France, 2014–2023: a nationwide population-based analysis

## TL;DR

This study analyzed ASM use in French children from 2014 to 2023, finding rising use of newer drugs and modest generic adoption.

## Contribution

The paper provides the first nationwide analysis of pediatric ASM trends in France, linking policy and usage patterns.

## Key findings

- Third-generation ASM use increased by 70% while first- and second-generation use declined.
- Valproate use dropped significantly, especially in girls, and lamotrigine and levetiracetam use rose.
- Generic ASM use increased from 11.2% to 20.2% over the study period, but remains low.

## Abstract

Epilepsy is the commonest chronic neurological disorder of childhood. In France, pregnancy-prevention rules and generic policies aim to improve safety and affordability of anti-seizure medications (ASM), but their paediatric impact is unknown. Tracking these patterns is key to assess policy effectiveness and to ensure safe, equitable, and sustainable access to treatment. We aimed to characterise nationwide temporal trends in paediatric ASM use, costs, generic uptake, and sex differences in France from 2014 to 2023.

We conducted a retrospective drug-utilisation study using open-access OpenMedic files from the French National Health Data System. All dispensing of 24 ASMs to individuals <18 years during 2014–23 were retrieved by product code. Annual users, boxes, and costs were summarised; temporal trends used Spearman tests; multivariable logistic regression modelled sex differences; LASSO selected determinants of generic dispensing.

Over the decade, 2,015,504 children consumed 15,748,141 ASM boxes, costing €274.4 million. Annual users increased 24% (from 174,889 to 216,607). Third-generation agents rose 70% (from 98,659 users per year to 168,290), whereas first- and second-generation agents fell 48% (from 1579 to 823) and 28% (from 87,929 to 63,038). Valproate use fell 37% overall (from 58,845 to 37,014) and 62% in girls (from 23,480 to 8975); lamotrigine and levetiracetam rose 49% (from 29,404 to 43,847) and 77% (from 37,290 to 65,940), respectively. Generics accounted for 11.2% of dispensing in 2014 (191,551 boxes) vs 20.2% in 2023 (455,934 boxes). Prescriptions by private psychiatrists and use of gabapentin, pregabalin, lamotrigine, and levetiracetam independently predicted generic uptake. ASM with available generic substitution would have cut 2023 spending by 8% (€3.88 million).

Paediatric ASM practice in France is rapidly aligning with safer, newer ASM and sex-specific risk mitigation, yet generic penetration lacks. Targeted substitution strategies could release funds for innovative therapies without compromising seizure control.

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