Association of topiramate prescribed for any indication with reduced alcohol consumption in electronic health record data

Background and Aims Topiramate is a medication that is widely prescribed to treat a variety of conditions, including alcohol use disorder (AUD). We used electronic health record (EHR) data to measure topiramate's effects on drinking in individuals differentiated by a history of AUD. Design Parallel‐groups comparison of patients prescribed topiramate and a propensity score‐matched comparison group. Setting A large US integrated health‐care system. Participants Patients with Alcohol Use Disorders Identification Test–Consumption (AUDIT‐C) scores prior to and after a minimum of 180 days of topiramate prescription for any indication and a propensity score‐matched group. The sample included 5918 patients with an electronic health record diagnosis of alcohol use disorder at any time (AUD‐hx‐pos) (1738 topiramate‐exposed and 4180 controls) and 23 614 patients with no EHR diagnosis of AUD (AUD‐hx‐neg) (6324 topiramate‐exposed and 17 290 controls). Measurements Regression analyses compared difference‐in‐difference (DiD) estimates, separately by AUD history. DiD estimates represent exposure‐group (i.e. topiramate versus control) differences on the pre–post difference in AUDIT‐C score. Effects of baseline AUDIT‐C score and daily topiramate dosage were also tested. Findings AUD‐hx‐neg patients who received topiramate had a greater reduction in AUDIT‐C score (−0.11) than matched controls (−0.04). This yielded a DiD score of −0.07 [95% confidence interval (CI) = −0.11,‐0.03; P = 0.002], with the greatest effect among AUD‐hx‐neg patients with a baseline AUDIT‐C score of 4+ (DiD = −0.35, 95% CI = –0.49, −0.21; P 150 mg/day of the medication (DiD = −0.15, 95%CI = –0.23, −0.07; P