Objective: To investigate the treatment patterns (TP), healthcare resource utilization (HCRU), and costs of essential tremor (ET) in a real-world setting in Germany using insurance claims data from a large representative [1,2] sample.

Background: ET is characterized by an uncontrolled rhythmic oscillation of upper limb muscle groups [3] and is recognized as a chronic, progressive disease [4]. Current pharmacologic therapy, despite its limited efficacy and side effects [5-7], remains the main therapeutic approach for patients. However, information regarding the overall TP of patients with ET is limited.

Method: This retrospective study utilized claims data from 01/01/2010 to 31/03/2022 provided by AOK PLUS (AOK) and GWQ ServicePlus (GWQ). Initially, a cohort of patients with ET was identified that had no diagnosis of another tremor-related neurologic disorder after initial ET diagnosis or prescription of a tremor-inducing agent in the 12 months before ET diagnosis. Subsequently, patients with newly diagnosed ET (defined as patients with a first ET diagnosis during the inclusion period with no prior ET diagnosis before the index diagnosis in the patient’s entire data availability history), were selected and followed to describe TP, HCRU, and costs.

Results: The newly diagnosed cohort included 4,568 and 5,538 patients in AOK and GWQ, respectively. Of these, 73.3% of patients in AOK and 63.1% in GWQ initiated a pharmacologic agent after ET diagnosis. Most frequently used drugs, given as monotherapy or in combination, were beta-blockers, specifically propranolol (AOK: 43.8%, GWQ: 49.9%), metoprolol (AOK: 27.1%, GWQ: 22.8%), and bisoprolol (AOK: 26.5%, GWQ: 24.2%), followed by the anticonvulsant primidone (AOK: 21.1%, GWQ: 13%). Other drugs used were mirtazapine, pregabalin & gabapentin among others. Median time to treatment initiation after ET diagnosis was 2.1 (AOK) and 6.3 (GWQ) months. Median time from treatment initiation to discontinuation of the first therapy was 3.5 (AOK) and 2.9 (GWQ) months, with 59.1% (AOK) and 67.4% (GWQ) of patients discontinuing treatment in the first six months and 71.9% (AOK) and 78.7% (GWQ) in the first year.

Conclusion: Our findings revealed a substantial proportion of patients either discontinuing treatment during follow-up or never treated. Despite several treatment options, most patients received traditional beta-blockers, which highlights the need for new pharmacological agents specifically targeted for ET.

References: [1] Surmann B, Witte J, Batram M, Criée CP, Hermann C, Leischker A, Schelling J, Steinmüller M, Wahle K, Heiseke AF, Marijic P. Epidemiology of Pertussis and Pertussis-Related Complications in Adults: A German Claims Data Analysis. Infect Dis Ther. 2024 Feb;13(2):385-399. doi: 10.1007/s40121-023-00912-z. Epub 2024 Jan 31. PMID: 38294623; PMCID: PMC10904701.
[2] Schuster AK, Leisle L, Picker N, Bubendorfer-Vorwerk H, Lewis P, Hahn P, Wasem J, Finger RP. Epidemiology of Diagnosed Age-related Macular Degeneration in Germany: An Evaluation of the Prevalence Using AOK PLUS Claims Data. Ophthalmol Ther. 2024 Apr;13(4):1025-1039. doi: 10.1007/s40123-024-00901-6. Epub 2024 Feb 22. PMID: 38386186; PMCID: PMC10912065.
[3] Haubenberger D, Hallett M. Essential tremor. N Engl J Med. 2018;378(19):1802-1810. doi:10.1056/nejmcp1707928.
[4] Bhatia KP, Bain P, Bajaj N, et al. Consensus statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33(1):75-87. doi:10.1002/mds.27121.
[5] Antonazzo IC, Rozza D, Conti S, Fornari C, Cortesi PA, Eteve-Pitsaer C, Paris C, Gantzer L, Valentine D, Mantovani LG, Mazzaglia G. Treatment patterns in essential tremor: Real-world evidence from a United Kingdom and France primary care database. Eur J Neurol. 2024;31(1):e16064. doi: 10.1111/ene.16064.
[6] Vetterick, C., Lyons, K.E., Matthews, L.G. et al. The Hidden Burden of Disease and Treatment Experiences of Patients with Essential Tremor: A Retrospective Claims Data Analysis. Adv Ther 2022;39:5546–5567. https://doi.org/10.1007/s12325-022-02318-8
[7] Louis ED, Rios E, Henchcliffe C. How are we doing with the treatment of essential tremor (ET)?: Persistence of patients with ET on medication: data from 528 patients in three settings. Eur J Neurol. 2010 Jun 1;17(6):882-4. doi: 10.1111/j.1468-1331.2009.02926.x. Epub 2010 Jan 7. PMID: 20067514; PMCID: PMC2889923.

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