Prescription Pattern of Antiepileptic Drugs in Southern Pakistan: A Retrospective Cohort Study in Tertiary Care Centres

Abstract

Epilepsy is the most occurring neurological disorder after stroke. Prevalence of epilepsy is about 9.99 per 1000 population in Pakistan. In recent years, about 14 new antiepileptic drugs (AEDs) have been marketed. Irrational drugs prescribing might decrease patient adherence with therapy and cause therapeutic failure. The aim of the current study was to evaluate the incidence of different types of epilepsy with syndromes and use of AEDs in patients with epilepsy in detail in a population, characterized by gender and age differences, with focus on exposure of AEDs, in Karachi-Pakistan. It reveals the results of a retrospective cohort study conducted during the period of June 2015 to May 2017 at General Neurology wards of different tertiary care hospitals of Karachi, Pakistan. Prescriptions (n = 90,356) were randomly collected along with the diagnostic data of patients with epilepsy. Variables included exposure of AEDs, polytherapy, age and gender differences, AEDs dosages and Non-AEDs in the same prescription. Total of 21 AEDs were utilized during the two-year study. Variations in the prescription pattern were noticed with respect to age and gender differences. Seventy-four percent of patients with epilepsy have utilized more than one AED. Levetiracetam (38%) was the most prescribed drug among all AEDs used in hospitals of Karachi, Pakistan. Valproic acid was still the most commonly utilized AED in children after inclusion its name in black box warning drug list. This study revealed the discrepancies related to dosages of commonly prescribed AEDs. The study indicates higher prevalence of irrational use of AEDs and the discrepancies in the dosing of mostly drugs. The achieved outcomes may provide sufficient basis for pharmacovigilance studies to health care authorities. RezumatEpilepsia este cea mai frecventă tulburare neurologică ce apare după accident vascular cerebral. Prevalența epilepsiei este d e aproximativ 9,99 la 1000 locuitori în Pakistan. În ultimii ani, au fost comercializate aproximativ 14 noi medicamente antiepileptice (AEDs). Medicamentele irațional prescrise scad complianța pacientului la terapie și induce insuficiență terapeutică. Scopul studiului a fost de a evalua incidența diferitelor tipuri de epilepsie și utilizarea AEDs la pacienții cu epilepsie, în Karachi-Pakistan. Este prezentat un studiu retrospectiv de cohortă, realizat în perioada iunie 2015mai 2017 în secțiile de neurologie ale unor spitale din Karachi, Pakistan. Prescripțiile (n = 90.356) au fost colectate aleatoriu împreună cu datele de diagnostic ale pacienților. Variabilele au inclus expunerea la AEDs, politerapia, vârsta, sexul, dozele de AEDs și non-AEDs pe aceeași prescripție. 21 de AEDs au fost utilizate pe parcursul celor doi ani de studiu. 74% dintre pacienții cu epilepsie au utilizat mai mult de un AED. Levetiracetamul (38%) a fost cel mai prescris medicament. Acidul valproic a fost cel mai frecvent utilizat AED la copii. Acest studiu a relevat discrepanțele legate de dozele de AEDs frecvent prescrise.

Analysis of treatment adherence and cost among patients with epilepsy: a four‐year retrospective cohort study in Pakistan

“…Data were collected from patients with epilepsy who received AEDs for the first time. Patients who received following top five prescribed anti-epileptic drugs as descending order are as follows, levetiracetam, valproic acid, carbamazepine, lamotrigine, lacosamide while phenobarbital, phenytoin, gabapentin, pregabalin and oxcarbazepine were considered as others AEDs [ 13 ]. Data of participants who died or left from the study due to any reason were not included.…”

“…Previously, pharmacoeconomics, adherence and persistence with AEDs have been reported using various methods in different countries [ 15 – 19 ]. In our previous study, we have reported the prescribing patterns of AEDs in Southern Pakistan [ 13 ]. However, according to our literature study, in Pakistan, no such study was conducted regarding the patient’s adherence and cost analysis of AEDs.…”

“…It has been reported that 25 to 75 % of patients with epilepsy, fail to adhere to initially prescribed AEDs [9][10][11][12]. Various study on analysis of medications usage produced significant impact on prescribing practices of medical practitioners [13,14].…”

Study Regarding the Determination of Valproic Acid Serum Levels by Emit

“…Bioavailability is reported to be approximately 90% for all oral formulations with enteric-coated forms possibly reaching 100% [30]. The anticonvulsant mechanism of action of valproic acid seems to be the cerebral increase of GABA, especially within the grey matter of the brain, which is involved in controlling and propagating convulsions [3,13]. The mechanism of action of valproic acid is still unclear, but it is assumed that while cerebral concentrations of gamma aminobutiric acid (GABA) increase, a decrease of monophosphate cyclic guanosine monophosphate is recorded (CGMP) [24].…”