Oxcarbazepine tied to increased risk of fragility fracture in children

In the treatment of children with epilepsy, oxcarbazepine (OXC), but not levetiracetam (LEV), appears to contribute to a higher risk of fragility fracture, a study has found.

The study used claims data extracted from the Optum Clinformatics Data Mart and included children aged 4–13 years at baseline with at least 5 years of continuous health plan enrolment, with a 1-year baseline (eg, prior to initiation of antiseizure medications [ASMs]) and 4 years of follow-up.

All the children were ASM-naïve and were grouped based on whether ASM treatment initiation included LEV or OXC. There also was a comparison group that included children without epilepsy and without ASM exposure. Nontrauma fracture was estimated as a claims-based proxy for fragility fracture.

During 4 years of follow-up, nontrauma fracture had a crude incidence rate (IR) of 21.5 (95 percent confidence interval [CI], 21.2–21.8) in the control group (n=271,346), 19.8 (95 percent CI, 12.3–27.2) in the LEV group (n=358), and 34.4 (95 percent CI, 21.1–47.7) for the OXC group (n=203).

Compared with the control group, the OXC group had an elevated incidence of nontrauma fractures (IR ratio [IRR], 1.60, 95 percent CI, 1.09–2.35), whereas the LEV group did not show any increase (IRR, 0.92, 95 percent CI, 0.63–1.34). Likewise, the OXC group had a greater incidence of nontrauma fractures compared with the LEV group (IRR, 1.74, 95 percent CI, 1.02–2.99).

The findings were consistent after adjusting for covariates, except when comparing OXC to LEV (hazard ratio, 1.71, 95 percent CI, 0.99–2.93), which was marginally statistically insignificant (p=0.053).

Studies are needed to determine whether these children could benefit from adjunct bone fragility therapies.