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Naji Y, Hrouch W, Laadami S, Adali N. Anti-seizure medication prescription preferences: a Moroccan multicenter study. Front Neurol 2024; 15:1435075. [PMID: 39246605 PMCID: PMC11378524 DOI: 10.3389/fneur.2024.1435075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/25/2024] [Indexed: 09/10/2024] Open
Abstract
Background The management of epilepsy is mainly based on antiseizure medications (ASMs). More than 20 ASMs have been introduced in clinical practice, providing a multitude of prescription choices. To date, there are no published data on the trends in ASMs prescriptions in Morocco. Therefore, we conducted a survey among practicing neurologists in seven tertiary referral hospitals in Morocco to study the current ASMs prescription preferences and their modifying factors. Methods Our descriptive and analytical cross-sectional study was based on a survey sent between January and April 2022 to neurologists practicing in seven tertiary referral hospitals in Morocco. Information regarding the prescription of ASMs was collected using an exploitation form and analyzed using the SPSS version 13 software. Results Based on questionnaire responses, our results showed that Valproic acid (96.3%) and Lamotrigine (59.8%) were the two most prescribed ASMs for generalized seizure types. For focal seizure types, Carbamazepine (98.8%) and Levetiracetam (34.1%) were the most commonly prescribed drugs, whereas for combined focal and generalized seizure types, the combination of Valproic acid and Carbamazepine (38.55%) was the most prescribed. Phenobarbital was the most commonly prescribed ASM for status epilepticus (40.2%). These prescription preferences were mainly due to seizure types, cost, health insurance coverage, years of experience, and additional epileptology training (p < 0.05). Conclusion Our results show a shift in the prescription of ASMs in Morocco. Similar to many other countries, valproic acid and carbamazepine are considered the first-line treatments for generalized and focal seizure types. Some factors remain as major challenges in enhancing epilepsy management in Morocco.
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Affiliation(s)
- Yahya Naji
- "N.I.C.E." Research Team, "R.E.G.N.E." Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
- Neurology Department, Agadir University Hospital, Agadir, Morocco
| | - Wafa Hrouch
- "N.I.C.E." Research Team, "R.E.G.N.E." Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
- Neurology Department, Agadir University Hospital, Agadir, Morocco
| | - Sara Laadami
- "N.I.C.E." Research Team, "R.E.G.N.E." Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
- Neurology Department, Agadir University Hospital, Agadir, Morocco
| | - Nawal Adali
- "N.I.C.E." Research Team, "R.E.G.N.E." Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
- Neurology Department, Agadir University Hospital, Agadir, Morocco
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Ion-Channel Antiepileptic Drugs: An Analytical Perspective on the Therapeutic Drug Monitoring (TDM) of Ezogabine, Lacosamide, and Zonisamide. ANALYTICA 2021. [DOI: 10.3390/analytica2040016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The term seizures includes a wide array of different disorders with variable etiology, which currently represent one of the most important classes of neurological illnesses. As a consequence, many different antiepileptic drugs (AEDs) are currently available, exploiting different activity mechanisms and providing different levels of performance in terms of selectivity, safety, and efficacy. AEDs are currently among the psychoactive drugs most frequently involved in therapeutic drug monitoring (TDM) practices. Thus, the plasma levels of AEDs and their metabolites are monitored and correlated to administered doses, therapeutic efficacy, side effects, and toxic effects. As for any analytical endeavour, the quality of plasma concentration data is only as good as the analytical method allows. In this review, the main techniques and methods are described, suitable for the TDM of three AEDs belonging to the class of ion channel agents: ezogabine (or retigabine), lacosamide, and zonisamide. In addition to this analytical overview, data are provided, pertaining to two of the most important use cases for the TDM of antiepileptics: drug–drug interactions and neuroprotection activity studies. This review contains 146 references.
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Beydoun A, DuPont S, Zhou D, Matta M, Nagire V, Lagae L. Current role of carbamazepine and oxcarbazepine in the management of epilepsy. Seizure 2020; 83:251-263. [PMID: 33334546 DOI: 10.1016/j.seizure.2020.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023] Open
Abstract
Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Despite a dramatic increase in treatment options over the past 30 years, it still ranks fourth in the world's disease burden. There are now close to 30 antiepileptic drugs (AEDs), with more than two thirds introduced to the market after carbamazepine (CBZ) and one third after its derivative, oxcarbazepine (OXC). Following the introduction of these newer AEDs, the role of CBZ and OXC in the therapeutic armamentarium for seizure control and effective epilepsy management needs to be reviewed. The main guidelines list both CBZ and OXC as first-line options or second-line alternatives for the treatment of focal-onset epilepsy and primary generalized tonic-clonic seizures. While evidence suggests that overall AEDs have similar efficacy, some newer AEDs may be better tolerated than CBZ. In line with this, there have been changes in treatment patterns, with many variations across different countries. However, CBZ remains among the two or three most prescribed drugs for focal epilepsy in many countries, and is widely used across Europe, Africa, South America, and Asia, where it represents a good compromise between cost, availability, and effectiveness. OXC is among the first-choice options for the initial treatment of focal-onset seizures in several countries, including the US and China, where the oral suspension is commonly prescribed. This review provides guidance on the optimal use of these two drugs in clinical practice, including in children, the elderly, and in pregnancy.
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Affiliation(s)
- Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sophie DuPont
- Epilepsy Unit and Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, AP-HP, Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France; Université Paris Sorbonne, Paris, France
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Maha Matta
- Novartis Pharma Services, Dubaï, United Arab Emirates
| | | | - Lieven Lagae
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
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4
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Wolking S, Schulz H, Nies AT, McCormack M, Schaeffeler E, Auce P, Avbersek A, Becker F, Klein KM, Krenn M, Møller RS, Nikanorova M, Weckhuysen S, Consortium E, Cavalleri GL, Delanty N, Depondt C, Johnson MR, Koeleman BPC, Kunz WS, Marson AG, Sander JW, Sills GJ, Striano P, Zara F, Zimprich F, Weber YG, Krause R, Sisodiya S, Schwab M, Sander T, Lerche H. Pharmacoresponse in genetic generalized epilepsy: a genome-wide association study. Pharmacogenomics 2020; 21:325-335. [DOI: 10.2217/pgs-2019-0179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: Pharmacoresistance is a major burden in epilepsy treatment. We aimed to identify genetic biomarkers in response to specific antiepileptic drugs (AEDs) in genetic generalized epilepsies (GGE). Materials & methods: We conducted a genome-wide association study (GWAS) of 3.3 million autosomal SNPs in 893 European subjects with GGE – responsive or nonresponsive to lamotrigine, levetiracetam and valproic acid. Results: Our GWAS of AED response revealed suggestive evidence for association at 29 genomic loci (p <10-5) but no significant association reflecting its limited power. The suggestive associations highlight candidate genes that are implicated in epileptogenesis and neurodevelopment. Conclusion: This first GWAS of AED response in GGE provides a comprehensive reference of SNP associations for hypothesis-driven candidate gene analyses in upcoming pharmacogenetic studies.
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Affiliation(s)
- Stefan Wolking
- Department of Neurology & Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
- Department of Neurosciences, CHUM Research Center, University of Montreal, Montreal, H2X 0A9, Canada
| | - Herbert Schulz
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany
| | - Anne T Nies
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
- University of Tübingen, 72076 Tübingen, Germany
| | - Mark McCormack
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland
| | - Elke Schaeffeler
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
- University of Tübingen, 72076 Tübingen, Germany
| | - Pauls Auce
- Walton Centre NHS Foundation Trust, Liverpool, L33 4YD, UK
| | - Andreja Avbersek
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London & Chalfont Centre for Epilepsy, London, SL9 0RJ, UK
| | - Felicitas Becker
- Department of Neurology & Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Karl M Klein
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Rikke S Møller
- Danish Epilepsy Centre – Filadelfia, 4293 Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | | | - Sarah Weckhuysen
- Neurogenetics Group, Center for Molecular Neurology, VIB-University of Antwerp, 2650 Edegem, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, 2650 Edegem, Belgium
- Department of Neurology, Antwerp University Hospital, 2650 Edegem, Belgium
| | | | - Gianpiero L Cavalleri
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland
- Division of Brain Sciences, Imperial College Faculty of Medicine, London, SW2 2AZ, UK
| | - Norman Delanty
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland
- Division of Neurology, Beaumont Hospital, Dublin 9, Ireland
- The FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Michael R Johnson
- Division of Brain Sciences, Imperial College Faculty of Medicine, London, SW2 2AZ, UK
| | - Bobby PC Koeleman
- Department of Genetics, University Medical Center Utrecht, 3584 Utrecht, The Netherlands
| | - Wolfram S Kunz
- Institute of Experimental Epileptology & Cognition Research & Department of Epileptology, University of Bonn, 53127 Bonn, Germany
| | - Anthony G Marson
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London & Chalfont Centre for Epilepsy, London, SL9 0RJ, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), 2103 Heemstede, The Netherlands
| | - Graeme J Sills
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Pasquale Striano
- Pediatric Neurology & Muscular Diseases Unit, IRCCS ‘G. Gaslini’ Institute, 16147 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal & Child Health, University of Genova, 16147 Genova, Italy
| | - Federico Zara
- Laboratory of Neurogenetics and Neuroscience, IRCCS ‘G. Gaslini’ Institute, 16147 Genova, Italy
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Yvonne G Weber
- Department of Neurology & Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Roland Krause
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 4362 Esch-sur-Alzette, Luxembourg
| | - Sanjay Sisodiya
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London & Chalfont Centre for Epilepsy, London, SL9 0RJ, UK
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, 72076 Tübingen, Germany
- Department of Pharmacy & Biochemistry, University Tübingen, 72076 Tübingen, Germany
| | - Thomas Sander
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany
| | - Holger Lerche
- Department of Neurology & Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
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5
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Wolking S, Moreau C, Nies AT, Schaeffeler E, McCormack M, Auce P, Avbersek A, Becker F, Krenn M, Møller RS, Nikanorova M, Weber YG, Weckhuysen S, Cavalleri GL, Delanty N, Depondt C, Johnson MR, Koeleman BP, Kunz WS, Marson AG, Sander JW, Sills GJ, Striano P, Zara F, Zimprich F, Schwab M, Krause R, Sisodiya SM, Cossette P, Girard SL, Lerche H. Testing association of rare genetic variants with resistance to three common antiseizure medications. Epilepsia 2020; 61:657-666. [DOI: 10.1111/epi.16467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Stefan Wolking
- Neurology and Epileptology Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany
- Department of Neurosciences, Research Center of the University of Montreal Hospital Center (CRCHUM) University of MontrealMontreal Canada
| | - Claudia Moreau
- Department of Applied Sciences University of Quebec in Chicoutimi Saguenay Canada
| | - Anne T. Nies
- Dr. Margarete Fischer‐Bosch Institute of Clinical Pharmacology Stuttgart Germany
- University of Tübingen Tübingen Germany
| | - Elke Schaeffeler
- Dr. Margarete Fischer‐Bosch Institute of Clinical Pharmacology Stuttgart Germany
- University of Tübingen Tübingen Germany
| | - Mark McCormack
- Molecular and Cellular Therapeutics Royal College of Surgeons in Ireland Dublin Ireland
| | - Pauls Auce
- Walton Centre NHS Foundation Trust Liverpool UK
| | - Andreja Avbersek
- Department of Clinical and Experimental Epilepsy UCL Queen Square Institute of Neurology London UK
- Chalfont Centre for Epilepsy London UK
| | - Felicitas Becker
- Neurology and Epileptology Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany
| | - Martin Krenn
- Department of Neurology Medical University of Vienna Vienna Austria
| | - Rikke S. Møller
- Danish Epilepsy Centre ‐ Filadelfia Dianalund Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Marina Nikanorova
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Yvonne G. Weber
- Neurology and Epileptology Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany
- Department of Epileptology and Neurology University of Aachen Aachen Germany
| | - Sarah Weckhuysen
- Neurogenetics Group VIB‐UAntwerp Center for Molecular NeurologyAntwerp Belgium
- Laboratory of Neurogenetics Institute Born‐Bunge University of Antwerp Antwerp Belgium
- Department of Neurology Antwerp University Hospital Antwerp Belgium
| | - Gianpiero L. Cavalleri
- Molecular and Cellular Therapeutics Royal College of Surgeons in Ireland Dublin Ireland
- Division of Brain Sciences Imperial College Faculty of Medicine London UK
| | - Norman Delanty
- Molecular and Cellular Therapeutics Royal College of Surgeons in Ireland Dublin Ireland
- Division of Neurology Beaumont Hospital Dublin Ireland
- The FutureNeuro Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Chantal Depondt
- Department of Neurology Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
| | - Michael R. Johnson
- Division of Brain Sciences Imperial College Faculty of Medicine London UK
| | - Bobby P.C. Koeleman
- Department of Genetics University Medical Center Utrecht Utrecht Netherlands
| | - Wolfram S. Kunz
- Institute of Experimental Epileptology and Cognition Research and Department of Epileptology University of Bonn Bonn Germany
| | - Anthony G. Marson
- Department of Molecular and Clinical Pharmacology Institute of Translational Medicine University of Liverpool Liverpool UK
| | - Josemir W. Sander
- Department of Clinical and Experimental Epilepsy UCL Queen Square Institute of Neurology London UK
- Chalfont Centre for Epilepsy London UK
- Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede Netherlands
| | - Graeme J. Sills
- Department of Molecular and Clinical Pharmacology Institute of Translational Medicine University of Liverpool Liverpool UK
| | - Pasquale Striano
- IRCCS "G. Gaslini" Institute Genova Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova Genova Italy
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova Genova Italy
| | - Fritz Zimprich
- Department of Neurology Medical University of Vienna Vienna Austria
| | - Matthias Schwab
- Dr. Margarete Fischer‐Bosch Institute of Clinical Pharmacology Stuttgart Germany
- University of Tübingen Tübingen Germany
- Department of Clinical Pharmacology, Pharmacy and Biochemistry University Tübingen Tübingen Germany
| | - Roland Krause
- Luxembourg Centre for Systems Biomedicine University of Luxembourg Esch‐sur‐Alzette Luxembourg
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy UCL Queen Square Institute of Neurology London UK
- Chalfont Centre for Epilepsy London UK
| | - Patrick Cossette
- Department of Neurosciences, Research Center of the University of Montreal Hospital Center (CRCHUM) University of MontrealMontreal Canada
| | - Simon L. Girard
- Department of Applied Sciences University of Quebec in Chicoutimi Saguenay Canada
| | - Holger Lerche
- Neurology and Epileptology Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany
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Kalilani L, Faught E, Kim H, Burudpakdee C, Seetasith A, Laranjo S, Friesen D, Haeffs K, Kiri V, Thurman DJ. Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US. Neurology 2019; 92:e2197-e2208. [PMID: 30971487 PMCID: PMC6537131 DOI: 10.1212/wnl.0000000000007448] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023] Open
Abstract
Objective To estimate the treatment gap between a new epilepsy diagnosis and antiepileptic drug (AED) initiation in the United States. Methods Retrospective claims-based cohort study using Truven Health MarketScan databases (commercial and supplemental Medicare, calendar years 2010–2015; Medicaid, 2010–2014) and a validation study using PharMetrics Plus Database linked to LRx claims database (2009–2014). Persons met epilepsy diagnostic criteria, had an index date (first epilepsy diagnosis) with a preceding 2-year baseline (1 year for persons aged 1 to <2 years; none for persons <1 year), and continuous medical and pharmacy enrollment without epilepsy/seizure diagnosis or AED prescription during baseline. Outcomes included percentage of untreated persons (no AED prescription) up to 3 years' follow-up and comparative outcomes (incidence rate ratio: untreated persons/treated persons), including medical events and health care resource utilization. Results In the primary study, 59,970 persons met selection (or inclusion) criteria; 36.7% of persons with newly diagnosed epilepsy remained untreated up to 3 years after diagnosis. In the validation study (N = 30,890), 31.8% of persons remained untreated up to 3 years after diagnosis. Lack of AED treatment was associated with an adjusted incidence rate ratio (95% confidence interval) of 1.2 (1.2–1.3) for medical events, 2.3 (2.2–2.3) for hospitalizations, and 2.8 (2.7–2.9) for emergency department visits. Conclusions One-third of newly diagnosed persons remain untreated up to 3 years after epilepsy diagnosis. The increased risk of medical events and health care utilization highlights the consequences of delayed treatment after epilepsy diagnosis, which might be preventable.
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Affiliation(s)
- Linda Kalilani
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC.
| | - Edward Faught
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Hyunmi Kim
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Chakkarin Burudpakdee
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Arpamas Seetasith
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Scott Laranjo
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - David Friesen
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Kathrin Haeffs
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Victor Kiri
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - David J Thurman
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
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7
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Zelano J, Klecki J, Christensen J, Tomson T, Malmgren K. The provision of epilepsy care across Europe 2017: A 17-year follow-up survey. Epilepsia Open 2019; 4:144-152. [PMID: 30868124 PMCID: PMC6398096 DOI: 10.1002/epi4.12306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the resources available in the provision of epilepsy care across Europe and the developments since the International League Against Epilepsy (ILAE) survey published in 2003 (data collected in 2000). METHODS An updated online version of the European Epilepsy Services Inventory was distributed to all European chapters of the ILAE (N = 47) and responses were obtained from 33 chapters (response rate 70%). To assess trends and allow comparisons with the survey published in 2003, the responding countries were divided into 4 groups (Western, Central, Southern, and Eastern). Responses from European Union (EU) member states are reported as a subgroup (N = 23), since the current survey is a part of the EU-funded European Study on the Burden and Care of Epilepsy (ESBACE, www.esbace.eu). RESULTS The total number of physicians involved in epilepsy care had increased since 2000, with the largest increase seen for neurologists. The gap between the best- and the least-provided areas with regard to the competence of the providers had diminished. However, the density of comprehensive multidisciplinary epilepsy teams had not changed to any greater degree. The main problems reported by the chapters were to a large extent the same as in 2000 and included lack of specialists and specialist care, lack or underuse of epilepsy surgery, and problems regarding financing and resource allocation. Several chapters also highlighted problems with healthcare structure and organization. SIGNIFICANCE Although there have been some improvements concerning the availability of care for people with epilepsy in Europe over the last 17 years, there are still a number of problem areas with little improvement or where there are important regional differences.
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Affiliation(s)
- Johan Zelano
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Judith Klecki
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Torbjörn Tomson
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Kristina Malmgren
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
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Fadare JO, Sunmonu TA, Bankole IA, Adekeye KA, Abubakar SA. Medication adherence and adverse effect profile of antiepileptic drugs in Nigerian patients with epilepsy. Neurodegener Dis Manag 2018; 8:25-36. [DOI: 10.2217/nmt-2017-0044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: Medication adherence remains a major challenge among patients with epilepsy (PWE) with the adverse effect profile of antiepileptic drugs (AEDs) as one of its main drivers. Methods: This was a cross-sectional questionnaire-based study among PWE in selected Nigerian tertiary healthcare facilities using the Morisky Medication Adherence Scale and the Liverpool Adverse Effect Profile (LAEP). Results: 126 PWE from four tertiary healthcare facilities were included in this study comprising of 59 (46.8%) males and 67 (53.2%) females. Carbamazepine (104/70.7%), sodium valproate (23/15.6%) and phenytoin (11/7.5%) were the most commonly prescribed AEDs. Using the Morisky Medication Adherence Scale, 17.2, 38.3 and 44.5% of patients were classified as having high, medium and low adherence, respectively. The mean LAEP score was 23.69 ± 6.07. The most common reported adverse effects among respondents were tiredness (30.4%) and headache (22.5%). Conclusion: Medication adherence to AED was poor among patients in this study.
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Affiliation(s)
- Joseph O Fadare
- Department of Pharmacology & Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Taofiki A Sunmonu
- Neurology Unit, Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Idowu A Bankole
- Neurology Unit, Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Kehinde A Adekeye
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Sani A Abubakar
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Jost J, Raharivelo A, Ratsimbazafy V, Nizard M, Auditeau E, Newton CR, Preux PM. Availability and cost of major and first-line antiepileptic drugs: a comprehensive evaluation in the capital of Madagascar. SPRINGERPLUS 2016; 5:1726. [PMID: 27777862 PMCID: PMC5053963 DOI: 10.1186/s40064-016-3409-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/28/2016] [Indexed: 12/02/2022]
Abstract
Background The prevalence of epilepsy is high in Madagascar (23.5/1000), as is the treatment gap (estimated at 92 %). The health system of the country is underfunded; some AEDs are used, and the national drug policy does not encourage price regulation or the administration of generic agents. We conducted a cross-sectional study to assess the availability and cost of solid oral AED formulations in Antananarivo, capital of Madagascar. Data were gathered from all officially registered pharmacies (according to the drug agency list, updated in 2015) by means of telephone interviews lasting no more than 10 min and conducted by a native Malagasy speaker. With regard to other sources (hospitals, illicit sales) data were obtained at specific visits. The study received ethical approval from the Madagascar Ministry of Health. Findings A total of 91 of 100 pharmacies (the nine not included were because of an inoperative phone number), two of three public hospitals, and two illegal outlets were investigated. Sodium valproate was available in 84.6 % of the pharmacies, while carbamazepine and phenobarbital were available in 68.1 % and 36.3 % of the pharmacies, respectively, but phenytoin was not available in any supply chain. There were more originator brands than generic formulations, with a higher cost (range 20.3–81.1 %, median 40.7 %) compared to the equivalent generic. The public system had only a very limited choice of AED, but offered the lowest costs. Illicit sources were more expensive by 54.3 % for carbamazepine and 62.5 % for phenobarbital. Concerning the annual cost of treatment, the average percentage of the gross national income per capita based on the purchasing power parity was 29.8 %/19.0 % (brand/generic) for sodium valproate, 16.4 %/7.3 % (brand/generic) for carbamazepine, 8.9 %/5.1 % (brand/generic) for phenobarbital. Conclusions The main sources of AEDs were private pharmacies, but the stocks held were low. The financial burden was still important in the capital of Madagascar, mainly the consequence of a highly developed private sector at the expense of the public sector. Although sodium valproate remains the most expensive solution, it still remains the most available instead of phenobarbital. The most striking feature of this study concerns the cost of AEDs in the informal sector, mostly used because they are deemed to provide less costly drugs, the opposite was observed there. The assessment of the cost and availability of medicines was easily and quickly implemented. It provided a relevant focus of the situation in areas difficult to investigate, in terms of road network and geographical situation.
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Affiliation(s)
- Jeremy Jost
- INSERM, Univ. Limoges, CHU Limoges, Department of Pharmacy, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Adeline Raharivelo
- INSERM, Univ. Limoges, CHU Limoges, Department of Pharmacy, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France ; Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Voa Ratsimbazafy
- INSERM, Univ. Limoges, CHU Limoges, Department of Pharmacy, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Mandy Nizard
- INSERM, Univ. Limoges, CHU Limoges, Department of Pharmacy, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Emilie Auditeau
- INSERM, Univ. Limoges, CHU Limoges, Department of Pharmacy, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Charles R Newton
- Department of Psychiatry, University of Oxford, Oxford, UK ; KEMRI-Wellcome Trust Programme Centre for Geographical Medicine (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, Department of Pharmacy, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
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Baftiu A, Johannessen Landmark C, Rusten IR, Feet SA, Johannessen SI, Larsson PG. Changes in utilisation of antiepileptic drugs in epilepsy and non-epilepsy disorders-a pharmacoepidemiological study and clinical implications. Eur J Clin Pharmacol 2016; 72:1245-1254. [PMID: 27411937 DOI: 10.1007/s00228-016-2092-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/01/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate changes in utilisation of antiepileptic drugs (AEDs) in epilepsy and non-epilepsy disorders in Norway and furthermore to study the retention rates of the most commonly used AEDs in these indications in long-term use. METHODS The data consisted of all prescriptions of AEDs from Norwegian pharmacies in the Norwegian Prescription Database (NorPD) (2004-2012). Variables included anonymous data regarding age, gender, diagnosis specific reimbursement codes and utilisation of AEDs. RESULTS In recent years (2008-2012), the utilisation of AEDs in non-epilepsy disorders accounted for 45-53 % of the total use. In epilepsy, the most commonly used AED was lamotrigine, followed by levetiracetam, carbamazepine and valproate. Lamotrigine was also the predominant AED used in psychiatry, while pregabalin and gabapentin were mostly used in neuropathic pain. In migraine, topiramate predominated but accounted for <1 % of the total utilisation of AEDs. The majority of prescriptions were by general practitioners and only 20 % by specialists. Regardless of indication, newer AEDs had higher retention rates (34-48 %) and were used for a longer period before discontinuation. CONCLUSIONS The use of AEDs in non-epilepsy disorders is increasing and accounted for 53 % in 2012. Newer AEDs were predominantly used and demonstrated higher retention rates than older AEDs in all indications. This nationwide study demonstrates an increased exposure to AEDs in new patient groups, and details in prescription patterns and clinical and safety considerations should be closely monitored. This contributes to long-term post-marketing data of AED and accordingly improved pharmacovigilance.
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Affiliation(s)
- Arton Baftiu
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Cecilie Johannessen Landmark
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. .,The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway. .,Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
| | - Ida Rudberg Rusten
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Silje Andrea Feet
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Svein I Johannessen
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Pål G Larsson
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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