Epilepsi merupakan penyakit kronis dengan prevalensi tinggi pada pediatrik. Salah satu obat anti epilepsi yang banyak diresepkan pada pediatrik adalah asam valproat. Luaran klinis utama pengobatan anti epilepsi adalah tercapainya periode bebas kejang. Tercapainya luaran klinis epilepsi sulit diprediksi karena dipengaruhi oleh banyak faktor. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan luaran klinis pasien epilepsi pediatrik yang menggunakan asam valproat. Pengambilan data dilakukan melalui wawancara kepada orangtua/wali pasien. Epilepsi dikatakan terkontrol jika tercapai periode bebas kejang ≥6 bulan selama menggunakan asam valproat. Analisis data dilakukan dengan uji chi square atau uji Fisher, dilanjutkan dengan uji regresi logistik binomial. Pasien pada penelitian ini berjumlah 39 pasien. Sebagian besar pasien pediatri (64.1%) yang menggunakan terapi asam valproat memiliki epilepsi yang terkontrol, dengan 20 pasien (51.3%) menggunakan monoterapi asam valproat. Faktor yang berhubungan dengan luaran klinis pasien adalah jumlah obat antiepilepsi yang digunakan (p-value <0.05). Meskipun demikian, epilepsi yang tidak terkontrol dapat menjadi penyebab pasien diberikan politerapi.

The high prevalence of antiepileptic drug use in pediatrics increases the risk of side and toxic effects; therefore, it is necessary to monitor drug levels. Therapeutic drug monitoring is conducted through pharmacokinetics by calculating blood drug levels based on respondents' dose and frequency of therapy. This study aimed to determine the pharmacokinetics of antiepileptic drug levels and the correlation with clinical outcomes using descriptive observational design. Furthermore, the Indonesian Epilepsy Community collected respondents' data from June to July 2020 through online and telephone interviews. Out of the 11 respondents that recieved phenytoin, only 1 (9.09%) was in the therapeutic range (10–20 mg/L), while 10 (90.91%) were outside the therapeutic range (<10mg/L). From the 14 respondents that received phenobarbital, 8 (57.14%) were in the therapeutic range (15–40 mg/L), and 6 (42.86%) were outside the therapeutic range (<15 mg/L and >40 mg/L). From the 47 respondents that received valproic acid, 23 were administered through monotherapy, 7 (30.44%) were in the therapeutic range (50–100 mg/L), and 16 (69.56%) were outside the therapeutic range (<50 mg/L and >100mg/L). Out of the 24 respondents that received valproic acid as monotherapy, 18 (75%) were in the therapeutic range (50–100 mg/L), and 6 (25%) were outside the therapeutic range (<50 mg/L and >100mg/L). The results showed that there was no significant relationship (p>0.05) between drug levels and clinical outcome in respondents treated with either monotherapy or polytherapy of valproic acid. In conclusion, a total of 38 respondents (52.05%) had drugs levels outside the therapeutic range, while 35 (47.95%) had drug levels in the therapeutic range. Furthermore, respondents with drug levels outside the therapeutic range require direct monitoring of antiepileptic drug levels to avoid toxic effects and improve clinical outcomes.

Anti-epileptic drug (AED) has a narrow therapeutic index of drugs that a slight increase in dosage showed toxic effects. The therapeutic response is difficult to predict in malnutrition status because the patient with nutritional deficiency have more complicated problems likes hypoalbuminemia, macronutrient and micronutrients deficiency that affected the levels of AEDs. The nutritional deficiency could be a direct and indirect cause of ineffective AEDs therapy and also recurrent epilepsy. This study aims to describe the use of antiepileptic drugs in Indonesian children with poor nutritional status. The research design was observational studies with cross sectional random sampling to evaluate the AED doses of malnutrition status in children. All information was collected by spreading electronic forms and interviewing the parents by phone. The data were analyzed descriptively. Total of 8 malnourished children mostly included in the range of ages from >2 to 12 years (n=5; 62.50%) with means 3,9±2,7 years. The study showed valproic acid was bigger used in monotherapy (n=5; 62,50%) than polytherapy with carbamazepine or sodium phenytoin and phenobarbital. The means estimation of valproic acid monotherapy concentration in females’ group (n=2; 33,33%) showed sub-therapeutics level were Cssmin 26,09±0,57 mg/L and Cssmax 64,17±1,39 mg/L, also the means in males’ group (n=2; 33,33%) of valproic acid monotherapy were Cssmin   22.07±2,71 mg/L and Cssmax 54.27±6.66 mg/L. All of them included in good clinical outcome of free seizure > 6 months.

ARNI adalah terapi baru untuk pasien gagal jantung yang diakui pada 2016, yang merupakan kombinasi antara sacubitril (Neprilisin Inhibitor) dengan valsartan (ARB). Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas pengunaaan sacubitril/valsartan dengan enalapril pada pasien gagal jantung melalui metode literature review. Pencarian artikel dilakukan pada database Cochrane dan PubMed. Kata kunci yang digunakan disusun berdasarkan PICO (heart failure, sacubitril/valsartan atau LCZ696, enalapril, dan efficacy or effectiveness). Kriteria inklusi pada penelitian yaitu artikel dalam bahasa inggris, full text dan bebas akses, publikasi 2010-2020, dan penelitian RCT. Kriteria eksklusi yaitu artikel review. Pencarian dilakukan pada 10 Juli hingga 23 Juli 2020 dan 20 Desember 2020. Didapatkan hasil pencarian 160 artikel, setelah dilakukan seleksi dan eligibilitas diperoleh 16 artikel sesuai kriteria inklusi sebagai arikel primer, dan 2 artikel ditambahkan sebagai artikel sekunder. Penelitian membuktikan bahwa sacubitril/valsartan menurunkan kejadian readmisi dan memiliki skor kualitas hidup lebih baik dibandingkan enalapril, serta dapat menurunkan resiko kematian. Berdasarkan penelitian primer PARADIGM-HF dan 15 artikel analisis lanjutan, diketahui bahwa sacubitril/valsartan lebih bermanfaat dibandingkan enalapril pada pasien gagal jantung. Kata kunci: sacubitril/valsartan, enalapril, gagal jantung, literature review