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Introduction: Infantile spasms (IS) is a rare and devastating form of early childhood epilepsy. Two drugs are approved in the United States for treatment of IS, H.P. Acthar ® Gel (repository corticotropin injection, RCI) and Sabril ® (vigabatrin). Given real-world variation in treatment of patients with IS, this study characterized treatment patterns with IS medications and determined all-cause health care resource utilization (HCRU) during the 90 days before initiating therapy with RCI in patients with IS., Materials and Methods: Truven Health MarketScan ® Research Databases were used to identify commercially insured US patients <2 years of age at RCI initiation with an IS diagnosis, per label use, from 1/1/07 to 12/31/15; presence of an electroencephalogram following diagnosis was required to assure diagnosis. Diagnosis codes and dispensed IS treatments of interest (drug classes including corticosteroids, vigabatrin, and other antiepileptic drugs [AEDs] excluding vigabatrin) before RCI initiation were evaluated., Results: The 5 most common diagnoses other than IS observed in the study cohort (n=422) were "other convulsions," "acute upper respiratory infection," "esophageal reflux," "epilepsy, unspecified," and "abnormal involuntary muscle movements." Among the study cohort, 51.7% received RCI first; 38.9% received 1 drug class and 9.5% received >1 drug class before RCI initiation. Other AEDs were dispensed most often, either alone (31.3%) or with other drug classes (9.3%). Mean HCRU included 11.8 all-cause outpatient visits and 4.5 medications dispensed. Patients who received RCI or corticosteroids as their initial IS treatment had the lowest and second-lowest HCRU., Conclusion: In the 90 days before initiating RCI, patients with IS received multiple diagnoses and treatments, characterized by frequent HCRU. Use of RCI first (no prior IS medications) and AEDs first were associated with the lowest and highest HCRU, respectively, across all categories (all-cause outpatient visits, emergency department visits, hospital admissions, prescription medications)., Competing Interests: Laura S. Gold has received salary funding from Mallinckrodt Pharmaceuticals to compensate her for the time spent to conduct this research. Tara Nazareth was an employee and stockholder of Mallinckrodt Pharmaceuticals at the time of this research. Tzy-Chyi Yu is an employee and stockholder of Mallinckrodt Pharmaceuticals. Keith R. Fry is an employee and stockholder of Mallinckrodt Pharmaceuticals. Nancy Ho Mahler is an employee and stockholder of Mallinckrodt Pharmaceuticals. Royce W. Waltrip II is an employee and stockholder of Mallinckrodt Pharmaceuticals. Ryan N. Hansen has received consulting fees from Mallinckrodt Pharmaceuticals. Andrew Rava was a student intern with Mallinckrodt at the time of this research. The authors report no other conflicts of interest in this work., (© 2019 Gold et al.)