Antiepileptic Drug Titration and Related Health Care Resource Use and Costs

Fishman, Jesse; Kalilani, Linda; Song, Yan; Swallow, Elyse; Wild, Imane

doi:10.18553/jmcp.2018.17337

Cited by 15 publications

(26 citation statements)

References 26 publications

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“…Slow dose titration in pediatric patients was advocated to decrease side effects and to optimize treatment. 20 Consistent with previous work, a high follow-up rate was reported in this study -but the frequency of medication change was low, and average AEDs doses were lower than the recommended doses. In addition, this study reported a large percentage of patients on less than the recommended doses, which could explain most patients not having 100% response, along with a lack of significant difference between response at the start and end of follow-up.…”

Section: Resultssupporting

confidence: 92%

“…Although slow dose titration is desirable, physicians must balance this with some rapid decisions to respond to improvement on the patient's side. 19,20 Despite that side effects were assessed at each visit, adherence was not checked. Therefore, it was not possible to conclude that the presence of an adverse effect affected drug compliance or subsequent response.…”

Section: Resultsmentioning

confidence: 99%

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Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs

Albsoul-Younes

Masri

Gharaibeh

et al. 2020

NSJ

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Objectives: To investigate the frequency of changes in antiepileptic drugs)AEDs(use, as well as concomitant changes in the degree of seizure control in pediatric patients, who are receiving 2 or more AEDs. Methods: A prospective follow-up study at Jordan University Hospital's pediatric neurology clinics was Original Article conducted on epileptic pediatric patients receiving at least 2 AEDs between December 2013 and April 2014. Patients were followed for 12 months. Results: A total of 82 patients were included, with a mean age of 7.2±4.7 years. The mean number of AEDs received by patients at enrollment was 2.4±0.6, and 2.5±0.7 after follow-up. Most patients)63.4%(experienced no change in seizure control, and the majority reported at least one adverse drug reaction. Most patients received lower doses than recommended, both at the beginning and end of the study. During the year, only 3 patients)4%(were eligible for dose tapering, which would then be converted to monotherapy. Follow-up appointments average was 4.2±2.9 visits/patients in one year. The frequency of medication changes and dose adjustment was very low, about one-third)29.3%(of patients requiring no change in AEDs during any follow-up visits. Conclusion: During the one year follow-up study, most patients on polytherapy maintained their level of response to the AEDs, with minimal changes in their regimen despite frequent follow-up visits. Only a small percent could be converted to AEDs monotherapy.

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Section: Resultssupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs

Albsoul-Younes

Masri

Gharaibeh

et al. 2020

NSJ

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“…However, a conservative approach was assumed in the simulation, and the January 2019 cost [53] of the most affordable retail drugs (excluding value-added tax) and package sizes formulated as capsules or tablets were used. Titration periods of perampanel and the subsequent AEDs (rounded to the closest full pack) used after brivaracetam or perampanel were modeled based on the summaries of product characteristics (SPC) and a study by Fishman et al [54]. AED dosing at the maintenance phase was based on Finnish data published by Mäkinen et al [17].…”

Section: Costsmentioning

confidence: 99%

“…The primary aim of epilepsy treatment is to minimize the number of seizures experienced by patients and to ensure that there are as few treatment-emergent adverse events (TEAEs) as possible. Sillanpää et al [15] estimated that epilepsy costs (in Euros) were €176 million in Finland in 2004, 54.5% of which included costs from registries that were indirect costs resulting from sick leave, early retirement, and premature deaths. In Sweden, indirect costs declined between 2005 and 2011 on increasing the use of AEDs [16].…”

Section: Introductionmentioning

confidence: 99%

Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland

et al. 2019

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Introduction: There is an unmet need for welltolerated antiepileptic drugs (AEDs) that effectively control focal onset seizures. This study aimed to evaluate the economic value of new AEDs in the treatment of focal onset seizure, with or without secondary generalization, in Finnish adults and adolescents with epilepsy, comparing brivaracetam with perampanel as adjunctive AEDs. Methods: Economic value was assessed using cost-utility analysis. Periods of AED initiation, titration, response assessment (seizure freedom, C 50% reduction, no response), switching in no response or treatment-emergent adverse events (TEAEs), and death were simulated using a discrete-event simulation model. Responses and switching were simulated based on a comprehensive Bayesian network meta-analysis. The primary modeled outcome was the 3%/year discounted incremental cost-effectiveness ratio (ICER). Discounted quality-adjusted life-years (QALYs), payer costs (year 2017 Euro) per patient, and net monetary benefit (NMB) were secondary outcomes. Probabilistic and comprehensive deterministic sensitivity analyses were conducted. Results: Brivaracetam was more efficacious and had fewer TEAEs than perampanel and other AEDs. Modeled average 5-year QALYs and costs were 3.671 and €28,297 for brivaracetam and 3.611 and €27,979 for perampanel, respectively. The resulting ICER for brivaracetam versus Enhanced Digital Features To view enhanced digital features for this article go to

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“…Dose titration is commonly used in most AEDs to decrease the adverse events and improve tolerability. [ 17 ] Measuring antiepileptic drug concentration level (therapeutic drug monitoring) is frequently used to optimize individual drug therapy. Monotherapy titration is titrating a single drug slowly and gradually to the desired dose.…”

Section: Introductionmentioning

confidence: 99%

Detrimental effect of antiepileptic drugs dose in pediatric children with epilepsy in Saudi Arabia

et al. 2021

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This study aims to evaluate the effect of dose titration for different oral antiepileptic medications among children with epilepsy in Riyadh, Saudi Arabia. A single-center prospective pilot, cohort study was undertaken at a tertiary hospital in Riyadh, Saudi Arabia. All medical records of pediatric patients below the age of 14 years of age who has been newly diagnosed with epilepsy by attending a medical specialist or on a new epileptic treatment plans were enrolled in the study. A total of 76 epileptic patients were screened for 3 months’ period and 48 patients were included in this study. Out of the 48 patients, 31 patients followed the regular practice in the titration processes and 17 patients were in the British national formulary (BNF) guideline. Fifteen children who were on monotherapy of levetiracetam were in regular practice guideline experienced poor seizure control with a recorded number of seizure incidence (n = 10). The patient in regular practice guidelines using a combination therapy of phenytoin and levetiracetam were experiencing some behavioral disturbance and sedation effect. Seventeen patients followed in the BNF guideline who were on levetiracetam were experienced less adverse effect (n = 2) with no behavioral changes. The group who followed the regular practice found having a greater incidence of documented adverse effects compared to the patients following the BNF guideline. The titrating antiepileptic medication has a detrimental effect on the pediatric population as observed in this study.

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Antiepileptic Drug Titration and Related Health Care Resource Use and Costs

Abstract: UCB Pharma sponsored this study and reviewed the manuscript. Fishman and Kalilani are employees of UCB Pharma. Wild was an employee of UCB Pharma at the time this analysis was conducted. Song and Swallow are employees of Analysis Group, which received funding from UCB Pharma.

Cited by 15 publications

References 26 publications

Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs

Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs

Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland

Detrimental effect of antiepileptic drugs dose in pediatric children with epilepsy in Saudi Arabia

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