Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital

Abstract

BackgroundEpilepsy is a common health problem which carries a huge medical social psychological and economic impact for a developing country. The aim of this hospital-based study was to get an insight into the effectiveness and tolerability of low cost antiepileptic drugs (AEDs) in Bangladeshi people with epilepsy.MethodsThis retrospective chart review was done from hospital records in weekly Epilepsy outdoor clinic of Department of Neurology, Dhaka Medical College Hospital (DMCH) from October 1998 to February 2013. A total of 854 epilepsy patients met the eligibility criteria (had a complete record of two years of follow up data) from hospital database. A checklist was used to take demographics (age and gender), epilepsy treatment and adverse event related data. At least two years of follow up data were considered for analysis.ResultsOut of 854 patients selected, majority of the patients attending outdoor clinic were >11-30 years age group (55.2%) with a mean age of 20.3 ± 9 years and with a male (53%) predominance. Focal epilepsy were more common (53%), among whom secondary generalized epilepsy was the most frequent diagnosis (67%) followed by complex partial seizure (21%). Among those with Idiopathic Generalized Epilepsy (46%), generalized tonic clonic seizure was encountered in 74% and absence seizure was observed in 13%. The number of patients on monotherapy and dual AED therapy were 67% and 24% respectively and polytherapy (i.e. >3 AEDs) was used only in 9%. CBZ (67%) was the most frequently prescribed AED, followed by VPA (43%), PHB (17%), and PHT (8%). CBZ was prescribed in 37% patients as monotherapy followed by VPA in 21% and PHB in 8% patients. Newer generation drugs eg lemotrigine and topiramate were used only as add on therapy in combination with CBZ and VPA in only 2% patients. The treatment retention rates over the follow up period for the AEDs in monotherapy varied between 86 and 91% and were highest for CBZ, followed by VPA. Most of the combination regimens had a treatment retention rate of 100%. The effectiveness of AED in terms of reduction of seizure frequency was highest for PHT (100%) and PHB (98%) followed by CBZ (96%) and VPA (95%). PHB and PHT were the cheapest of all AEDs (42 I$ and 56 I$/ year respectively). The costs of VPA and CBZ were two times and LTG and TOP were six to eight times higher. Adverse drug reaction (ADR) were observed among 140 (24.5%) of those with monotherapy. PHT (64%) was the most common drug to cause ADR, CBZ was at the bottom of the list to cause adverse effect (11.6%). VPA and PHB caused weight gain commonly. Adjustment of drug dose or withdrawal due to ADRs was necessary in 39% with PHT and 26% with PHB.ConclusionThough PHT and PHB are cheapest and efficacious among all, CBZ and VPA are less costly, effective and well tolerated drug for seizure control in context of Bangladesh.

Drug therapy problems and treatment satisfaction among ambulatory patients with epilepsy in a specialized hospital in Ethiopia

“…GTCS was found to be the commonest seizure type encountered, which is in line with studies conducted in Saudi Arabia (65%) [20] and Bangladesh (74%) [21]. Choice of the most appropriate AEDs depends on proper classification of seizures type.…”

Intensive Monitoring of Adverse Drug Reactions to Antiepileptic Drugs in Neurology Department of a Secondary Care Hospital in U.A.E

“…20 In contrast, in a study conducted by Mathur S et al phenytoin was responsible for most of the ADRs. 6 Also, the studies of Sebastian J et al 7 Jena M et al 18 and Habib M et al 21 showed that phenytoin was responsible for 53.3%, 51.6% and 64%, of the ADRs, respectively. The increase in the numbers of ADRs due to phenytoin in the previous studies is possibly due to the prescribing patterns of AED in those studies.…”

“…this higher predominance could be due to the high incidence of sodium valproate used by patients in the present study. While GI disturbances were most common ADR reported in the study of Sebastian J et al 7 Whereas gum hyperplasia was mostly experienced by the patients enrolled in the study of Habib M et al 21 In the study of Hansens Y et al…”

A Prospective Study of Drug Utilization Pattern of Anti-Epileptic Drugs and Their Adverse Effects in a Tertiary Care Hospital

“…Antiepileptic DUS in a Bangladesh medical college hospital in 2013concludes that the use of older AED's like valproate, CBZ, phenytoin, and phenobarbitone is a very cost-effective therapy in primary healthcare settings [29]. Valproate was also the only drug supplied free of cost during the study period in RMMCH pharmacy and this also could have been a reason for its wide use in prescriptions for seizures, as it mainly contributes in increasing the compliance of patients.…”