Dr Gabriel Davis Jones

A new app, EpiRisk, will provide real‐time risk analysis for anti-epileptic drugs (AEDs) in pregnancy, its Australian developers say.

The tool, based on Australian and UK pregnancy registers as well as literature databases, will enable clinicians to accurately estimate the risk of single and combination AED therapy. The data will thus better inform women who are contemplating pregnancy of the risks associated with their specific treatment regimen, according to neurologists at the Royal Melbourne Hospital and the Alfred Hospital, Melbourne, who are developing the system in conjunction with a team from Oxford University.

Writing in the journal Epilepsia Open, they say the task of estimating risk of congenital malformations and other adverse effects of AEDs in pregnancy has become much more complex with the advent of novel AEDs, new indications and the trend to use polytherapy.

According to co-developer Dr Gabriel Davis Jones of the Departments of Medicine and Neurology, The Royal Melbourne Hospital, the new EpiRisk system to be launched in late 2018 will be based on a blend of real time data from drug registries and up-to-date searches of the literature of AEDs and malformations via the PubMed database.

When tested in a proof-of-concept study the system was able to provide a relative risk of 3.98 for a child being born with an congential malformation to a woman with epilepsy who was taking valproate monotherapy compared to a woman not taking an AED.

“Having tested EpiRisk in a proof‐of‐concept study, we are now adding available datasets regarding mono‐ and polytherapy regimens to the platform,” the developers write.

“EpiRisk also allows clinicians to better encourage women to register with local pregnancy registries and provides easy access to the original literature and data, ensuring complete transparency relating to the risk estimates provided.

“EpiRisk may thus provide a future‐proof central hub for empowering patients, clinicians, and registries by delivering evidence‐based information on the teratogenic risk of the AEDs in pregnant women with epilepsy through an easily accessible platform.”

And as EpiRisk gains traction, the developers hope to collect long‐term developmental data on children who have been exposed to AEDs in utero and thereby further inform the data that EpiRisk provides in an iterative process.

“These new data are critically needed for the newer AEDs, and the multitude of combinations of AEDs that are now used in pregnant women,” they say