Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

Abstract

Objective: To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method: Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results: Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4-7.7). Conclusion: The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system. Keywords: epilepsy, refractory epilepsy, antiepileptic drugs, polytherapy, drug utilization. RESUMOObjetivo: Avaliar o perfil de utilização de fármacos antiepilépticos em uma população de pacientes adultos com epilepsia refratária atendidos em um centro terciário. Método: Análises descritivas dos dados obtidos dos registros médicos de 112 pacientes. Também foram consideradas as características clínicas e demográficas. Resultados: Foram prescritas politerapias com ≥3 antiepilépticos a 60,7% dos pacientes. Em relação aos fármacos de primeira geração, carbamazepina e clobazam foram os mais frequentemente prescritos (a 72,3% e 58,9% dos pacientes, respectivamente). Dentre os novos antiepilépticos, a lamotrigina foi o mais prescrito (36,6% dos pacientes). Ao menos um antiepiléptico de primeira geração foi encontrado em 103 das 104 politerapias; ao menos um novo antiepiléptico foi prescrito a 70,5% da população. A combinação mais prevalente foi carbamazepina+clobazan+lamotrigina. A carga média de antiepilépticos foi 3.3 (0.4 a 7.7). Conclusão: O padrão de utilização de antiepilépticos, embora concordante com guias atuais, é fortemente influenciado pelo sistema público de saúde.Palavras-chave: epilepsia, epilepsia refratária, fármacos antiepilépticos, politerapia, utilização de fármacos.Approximately one-third of the patients with epilepsy have recurrent seizures in spite of adequate pharmacological treatment and good compliance, characterizing what is known as refractory epilepsy 1 . The lack of control over seizure recurrence has a major impact not only on the patients' clinical and psychosocial status but also on economic consequences that could potentially overload the health care system due to avoidable expenses with regard to medications, hospitalizations, and examinations 2 .An important portion of the high costs related to the treatment of refractory epilepsy is devoted to the purchase of second-generation antiepileptic drugs (AED), which are more expensive than f...

Drug‐resistant epilepsy and topiramate: Plasma concentration and frequency of epileptic seizures

“…The prevalence of patients in combination therapy found in this study is in agreement with other studies conducted with patients with drug‐resistant epilepsy, since one of the main strategies for the control of seizures in drug‐resistant epilepsy is the association of AEDs.…”

Trends in Antiepileptic Drug Prescriptions for Childhood Epilepsy at a Tertiary Children’s Hospital in Korea, 2001–2012

“…Lamotrigine, which was the most prevalent newer AED in previous studies [29,30], was prescribed most frequently in children 2-5 years old. Topiramate comprised 7-8 % of prescriptions for children \2 years of age despite a lack of approval for use in this age group.…”

Depressão Em Pacientes Com Epilepsia Refratária Do Lobo Temporal Mesial

“…No entanto, cerca de um terço dos pacientes com epilepsia segue com convulsões recorrentes, apesar do uso de fármacos adequados e boa adesão ao tratamento, sendo esta classificada como epilepsia refratária (Freitas-Lima et al, 2013). A epilepsia refratária pode ser definida como a resistência a, pelo menos, duas drogas antiepilépticas utilizadas adequadamente, sem estabelecimento do controle das crises (Kwan et al, 2010 …”