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Watkins L, O'Dwyer M, Oak K, Lawthom C, Maguire M, Thomas R, Shankar R. The evidence for switching dibenzazepines in people with epilepsy. Acta Neurol Scand 2020; 142:121-130. [PMID: 32249420 DOI: 10.1111/ane.13248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/21/2020] [Accepted: 03/27/2020] [Indexed: 01/06/2023]
Abstract
The dibenzazepines particularly carbamazepine are associated with known adverse effects (AEs) and drug to drug interactions. Eslicarbazepine acetate (ESL) is structurally distinct from other members of the dibenzazepine family and has the advantage of once daily dosing. Observational and trial data report successful switching from older dibenzazepines to ESL. The evidence base for doing so is unclear and not standardized. This is a literature review following the PRISMA scoping guidelines identifying the evidence of switching dibenzazepines. Transition methods, ratios, tolerance to change, adverse effects and retention post-change were evaluated. Study quality was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. Seven studies investigated the outcome of transition between carbamazepine and or oxcarbazepine to ESL, with specific data on the transition dose ratio and scheduling. The available data suggest that the overnight transition between oxcarbazepine and ESL in a 1:1 ratio (most common) is generally well tolerated with high retention rates. The transition showed improvement in adverse events associated with oxcarbazepine across a variety of domains. Almost 60% transitioned because of adverse events experienced no further symptoms at 12 months. There is less data on the transition from carbamazepine to ESL. The evidence available suggests an overnight transition in the ratio of 1:1.3-1.5. The retention rate following transition from carbamazepine to ESL was 69% (follow-up of 4 months) with almost half of those transitioned because of adverse events experiencing no further symptoms. There is Grade C evidence available to help guide clinicians in the transition.
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Affiliation(s)
| | - Marie O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Ireland
| | - Katy Oak
- Royal Cornwall Hospital Trust Truro UK
| | - Charlotte Lawthom
- Aneurin Bevan University Health Board Newport UK
- Swansea University Swansea UK
| | - Melissa Maguire
- Leeds General Infirmary Leeds UK
- Leeds Institute of Biomedical & Clinical Sciences University of Leeds Leeds UK
| | - Rhys Thomas
- Institute of Neuroscience Newcastle University Newcastle‐upon‐Tyne UK
- Royal Victoria Infirmary Newcastle‐upon‐Tyne UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Threemilestone Industrial Estate Truro UK
- University of Exeter Medical School Knowledge Spa Truro UK
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Abstract
BACKGROUND Epilepsy is a common neurological disorder. In approximately 30% of epilepsy cases, seizures are uncontrolled by one antiepileptic drug (AED). These people require treatment with a combination of multiple AEDs and are described as having drug-resistant epilepsy. Oxcarbazepine is a keto-analogue of carbamazepine, an established AED, and can be used as an add-on treatment for drug-resistant epilepsy. OBJECTIVES To assess the efficacy and tolerability of oxcarbazepine as an add-on treatment for people with drug-resistant focal epilepsy. SEARCH METHODS The following databases were searched on 24 September 2018: Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL); Medline (Ovid) 1946 to 21 September 2018; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). Originally, we also searched SCOPUS as a substitute for Embase, but this is no longer necessary, because randomised and quasi-randomised controlled trials in Embase are now included in CENTRAL. SELECTION CRITERIA Randomised controlled trials with parallel-group or cross-over design, recruiting people of any age with drug-resistant focal epilepsy. We accepted any level of blinding and trials could be placebo- or active-controlled. DATA COLLECTION AND ANALYSIS In accordance with the methodological procedures expected by the Cochrane Collaboration, two review authors independently assessed trial eligibility before extracting data and assessing risk of bias. We assessed the primary outcomes: median percentage seizure reduction per 28 days; 50% or greater reduction in seizure frequency; and adverse effects including ataxia, hyponatraemia, and somnolence. We assessed the secondary outcomes: seizure freedom; treatment withdrawal; cognitive effects; and quality of life. We used an intention-to-treat population for all primary analyses. We present results as risk ratios (RR) with 95% confidence intervals (CI), with the exception of adverse effects which we present with 99% CI. MAIN RESULTS We identified six eligible studies, involving 1593 participants. We judged that three studies were at unclear risk of bias and three were at high risk of bias. Bias mainly arose from lack of methodological details and from high attrition rates. Participants were aged 1 month to 65 years, with a diagnosis of drug-resistant focal epilepsy. All studies were either placebo- or alternative-dose-controlled with parallel-group design. The treatment period varied from 9 days to 26 weeks. The median percentage seizure reduction per 28 days (3 studies; moderate-certainty evidence) ranged from 26% to 83.3% for participants randomised to experimental oxcarbazepine compared to 7.6% to 28.7% for participants randomised to control treatment. Oxcarbazepine may increase the responder rate for 50% or greater reduction in seizure frequency compared to control treatment (RR 1.80, 95% CI 1.27 to 2.56; random-effects model; 6 studies; low-certainty evidence). For seizure freedom, the RR was 2.86 (95% CI 1.19 to 6.87; random-effects model; 5 studies; low-certainty evidence), suggesting an advantageous effectiveness of oxcarbazepine over control treatment. Treatment with oxcarbazepine was associated with an increased treatment withdrawal rate compared to control (RR 1.75, 95% CI 1.44 to 2.13; fixed-effect model; 6 studies; moderate-certainty evidence). The largest oxcarbazepine dose used, 2400 mg/d, was associated with a higher treatment withdrawal rate (RR 2.38, 95% CI 1.92 to 2.94; fixed-effect model; 2 studies) compared to control, than 1200 mg/d (RR 1.54, 95% CI 1.21 to 1.95; fixed-effect model; 3 studies) or 600 mg/d oxcarbazepine (RR 0.79, 95% CI 0.55 to 1.15; fixed-effect model; 1 study). Treatment with oxcarbazepine was associated with an increased incidence of multiple adverse effects including: ataxia (RR 2.54, 99% CI 0.86 to 7.54; random-effects model; 5 studies; moderate-certainty evidence); and somnolence (RR 2.03, 99% CI 1.17 to 3.54; random-effects model; 6 studies; low-certainty evidence). Hyponatraemia occurred more frequently with oxcarbazepine treatment but not significantly so (RR 2.53, 99% CI 0.27 to 23.85; fixed-effect model; 6 studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS Oxcarbazepine might be effective at reducing seizure frequency when used as an add-on for drug-resistant focal epilepsy. The efficacy outcomes - 50% or greater seizure reduction and seizure freedom - were derived from low-certainty evidence. We are, therefore, uncertain whether the estimated effect size is representative of the true effect. In contrast, the evidence for median percentage seizure reduction and treatment withdrawal were of moderate certainty: thus, we are fairly certain of the effect estimates' reliability. Overall, we are unsure of the true efficacy of oxcarbazepine, but have concerns about its tolerability.
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Affiliation(s)
- Rebecca Bresnahan
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyLower LaneLiverpoolUKL9 7LJ
| | | | - Anthony G Marson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyLower LaneLiverpoolUKL9 7LJ
- The Walton Centre NHS Foundation TrustLiverpoolUK
- Liverpool Health PartnersLiverpoolUK
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Banach M, Miziak B, Borowicz-Reutt KK, Czuczwar SJ. Advances with extended and controlled release formulations of antiepileptics in the elderly. Expert Opin Pharmacother 2018; 20:333-341. [DOI: 10.1080/14656566.2018.1549543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Monika Banach
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin, Lublin, Poland
| | - Barbara Miziak
- Department of Pathophysiology, Medical University of Lublin, Lublin, Poland
| | - Kinga K. Borowicz-Reutt
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin, Lublin, Poland
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El-Zaafarany GM, Soliman ME, Mansour S, Cespi M, Palmieri GF, Illum L, Casettari L, Awad GAS. A Tailored Thermosensitive PLGA-PEG-PLGA/Emulsomes Composite for Enhanced Oxcarbazepine Brain Delivery via the Nasal Route. Pharmaceutics 2018; 10:E217. [PMID: 30400577 PMCID: PMC6321319 DOI: 10.3390/pharmaceutics10040217] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
The use of nanocarrier delivery systems for direct nose to brain drug delivery shows promise for achieving increased brain drug levels as compared to simple solution systems. An example of such nanocarriers is emulsomes formed from lipid cores surrounded and stabilised by a corona of phospholipids (PC) and a coating of Tween 80, which combines the properties of both liposomes and emulsions. Oxcarbazepine (OX), an antiepileptic drug, was entrapped in emulsomes and then localized in a poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) triblock copolymer thermogel. The incorporation of OX emulsomes in thermogels retarded drug release and increased its residence time (MRT) in rats. The OX-emulsome and the OX-emulsome-thermogel formulations showed in vitro sustained drug release of 81.1 and 53.5%, respectively, over a period of 24 h. The pharmacokinetic studies in rats showed transport of OX to the systemic circulation after nasal administration with a higher uptake in the brain tissue in case of OX-emulsomes and highest MRT for OX-emulsomal-thermogels as compared to the IN OX-emulsomes, OX-solution and Trileptal® suspension. Histopathological examination of nasal tissues showed a mild vascular congestion and moderate inflammatory changes around congested vessels compared to saline control, but lower toxic effect than that reported in case of the drug solution.
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Affiliation(s)
- Ghada M El-Zaafarany
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Monazzamet Elwehda Elafrikeya Street, Abbaseyya, Cairo 11566, Egypt.
| | - Mahmoud E Soliman
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Monazzamet Elwehda Elafrikeya Street, Abbaseyya, Cairo 11566, Egypt.
| | - Samar Mansour
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Monazzamet Elwehda Elafrikeya Street, Abbaseyya, Cairo 11566, Egypt.
- Department of Pharmaceutical Technology, Faculty of Pharmacy and Biotechnology, German University in Cairo, Al-Tagmoaa Alkhames, Cairo 11835, Egypt.
| | - Marco Cespi
- School of Pharmacy, University of Camerino, Via S. Agostino 1, 62032 Camerino (MC), Italy.
| | | | - Lisbeth Illum
- IDentity, 19 Cavendish Crescent North, The Park, Nottingham NG7 1BA, UK.
| | - Luca Casettari
- Department of Biomolecular Sciences, School of Pharmacy, University of Urbino, Piazza del Rinascimento 6, 61029 Urbino (PU), Italy.
| | - Gehanne A S Awad
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Monazzamet Elwehda Elafrikeya Street, Abbaseyya, Cairo 11566, Egypt.
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Abstract
INTRODUCTION Extended-release (ER) preparations are either available or have been tested for several antiepileptic drugs (AEDs). Indeed, they may be helpful in improving efficacy, tolerability, adherence, compared to the corresponding immediate release (IR) preparations available. The use of ER preparations has been advocated in women of childbearing age and is - depending on the drug - especially helpful in patients who are treated in combination with enzyme inducing AEDs as well as in children. AREAS COVERED Clinical and pharmacokinetic studies on ER formulations of AEDs were identified by a PubMed literature research. Further references were added from the authors' personal knowledge and from the reference lists of the identified studies. Reviews and expert commentaries were included, where necessary. EXPERT OPINION Unfortunately, studies providing direct comparisons of ER and IR formulations of a given drug are only available for a handful of drugs. ER preparations are especially helpful in drugs with a short elimination half-life and concentration-depending efficacy and tolerability.
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Affiliation(s)
| | - Theodor W May
- b Society for Epilepsy Research , Bielefeld , Germany
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Elger C, Koepp M, Trinka E, Villanueva V, Chaves J, Ben-Menachen E, Kowacs PA, Gil-Nagel A, Moreira J, Gama H, Rocha JF, Soares-da-Silva P. Pooled efficacy and safety of eslicarbazepine acetate as add-on treatment in patients with focal-onset seizures: Data from four double-blind placebo-controlled pivotal phase III clinical studies. CNS Neurosci Ther 2017; 23:961-972. [PMID: 29030894 PMCID: PMC5813188 DOI: 10.1111/cns.12765] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose Pooled evaluation of the key efficacy and safety profile of eslicarbazepine acetate (ESL) added‐on to stable antiepileptic therapy in adults with focal‐onset seizures. Methods Data from 1703 patients enrolled in four phase III double‐blind, randomized, placebo‐controlled studies were pooled and analyzed. Following a 2 week titration period, ESL was administered at 400 mg, 800 mg, and 1200 mg once‐daily doses for 12 weeks (maintenance period). Pooled efficacy variable was standardized (/4 weeks) seizure frequency (SSF) analyzed over the maintenance period as reduction in absolute and relative SSF and proportion of responders (≥50% reduction in SSF). Pooled safety was analyzed by means of adverse events and clinical laboratory assessments. Results SSF was significantly reduced with ESL 800 mg (P < 0.0001) and 1200 mg (P < 0.0001) compared to placebo. Median relative reduction in SSF was 33.4% for ESL 800 mg and 37.8% for 1200 mg (placebo: 17.6%), and responder rate was 33.8% and 43.1% (placebo: 22.2%). ESL was more efficacious than placebo regardless of gender, geographical region, epilepsy duration, age at time of diagnosis, seizure type, and type of concomitant antiepileptic drugs (AED). Incidence of adverse events (AEs) and AEs leading to discontinuation was dose dependent. Most common AEs (>10% patients) were dizziness, somnolence, and nausea. The incidence of treatment‐emergent AEs (dizziness, somnolence, ataxia, vomiting, and nausea) was lower in patients who began taking ESL 400 mg (followed by 400 mg increments to 800 or 1200 mg) than in those who began taking ESL 600 mg or 800 mg. Conclusions Once‐daily ESL 800 mg and 1200 mg showed consistent results across all efficacy and safety endpoints, independent of study population characteristics and type of concomitant AEDs. Treatment initiated with ESL 400 mg followed by 400 mg increments to 800 or 1200 mg provides optimal balance of efficacy and tolerability.
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Affiliation(s)
- Christian Elger
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Mathias Koepp
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Vicente Villanueva
- Unidad Multidisciplinar de Epilepsia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - João Chaves
- Serviço de Neurologia, Hospital S. António, Centro Hospitalar do Porto, Porto, Portugal
| | - Elinor Ben-Menachen
- Department of Clinical Neuroscience and Physiology, Sahlgren Academy, Sahlgren University Hospital, Göteborg, Sweden
| | | | | | - Joana Moreira
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - Helena Gama
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - José-Francisco Rocha
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal.,Department of Biomedicine, Faculty of Medicine, Unit of Pharmacology and Therapeutics, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Schmid E, Kuchukhidze G, Kirschner M, Leitinger M, Höfler J, Rohracher A, Kalss G, Wendling AS, Steinhoff BJ, Trinka E. Overnight switching from oxcarbazepine to eslicarbazepine acetate: an observational study. Acta Neurol Scand 2017; 135:449-453. [PMID: 27444636 DOI: 10.1111/ane.12645] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are clinical situations where it might be appropriate to switch patients from immediate-release oxcarbazepine (OXC) to eslicarbazepine acetate (ESL). We investigated the effects of transitioning patients overnight from OXC to ESL. MATERIALS AND METHODS A retrospective, single-center study was conducted in which patients with drug-resistant focal epilepsy on a stable dose of immediate-release OXC for at least 4 weeks were switched overnight to ESL. Patients were switched because they experienced persistent seizures with OXC but were unable to tolerate increased OXC dosing due to adverse events. Tolerability was assessed using the Adverse Events Profile (AEP), quality of life was assessed using the Quality of Life in Epilepsy Inventory 10 (QOLIE-10), and alertness was assessed as reaction time using a subtest of the Test Battery for Attention Performance version 2.3. Assessments were performed immediately prior to and 5 days after switching from OXC to ESL (days 0 and 5, respectively). RESULTS The analysis included 21 patients (12 women, 9 men; mean age 36 years). After switching from OXC to ESL, there were significant improvements in mean scores for AEP (P<.001), QOLIE-10 (P=.001), and alertness (P<.05). Adverse Events Profile total scores improved for 21/21 (100.0%) patients, QOLIE-10 total scores improved for 17/21 (81.0%) patients, and alertness scores improved for 16/21 (76.2%) patients. CONCLUSIONS In this short-term, single-center study, an overnight switch from twice-daily OXC to once-daily ESL in patients with drug-resistant focal epilepsies resulted in improvements in side effects, quality of life, and alertness.
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Affiliation(s)
- E. Schmid
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
| | - G. Kuchukhidze
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - M. Kirschner
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
- Neuroscience Institute; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
| | - M. Leitinger
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
| | - J. Höfler
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
| | - A. Rohracher
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
| | - G. Kalss
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
| | | | | | - E. Trinka
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University, and Centre for Cognitive Neuroscience; Salzburg Austria
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Sattler A, Schaefer M, May TW. Relationship between mono-hydroxy-carbazepine serum concentrations and adverse effects in patients on oxcarbazepine monotherapy. Seizure 2015; 31:149-54. [PMID: 26362393 DOI: 10.1016/j.seizure.2015.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the relationship between serum concentrations of mono-hydroxy-carbazepine (MHD), the main metabolite of oxcarbazepine (OXC), and the occurrence of adverse effects (AE) in a large group of patients on OXC monotherapy. METHODS An antiepileptic drug (AED) therapeutic drug monitoring (TDM) database was analyzed especially with regard to OXC dosage, MHD serum concentration, and the occurrence of AE. In total, 893 blood samples of 442 patients were included in this retrospective study. The statistical evaluation was performed by means of Kaplan-Meier estimates, log-rank tests and generalized estimating equations (GEE). RESULTS At least one AE was reported in 78 (17.6%) of the 442 patients. At MHD serum concentrations of 30.0 μg/ml and 43.7 μg/ml and OXC dosages of 33.1 mg/kg and 62.3 mg/kg, 25% and 75% of patients, respectively, experienced at least one AE. Log-rank tests indicated that younger patients (<18 years) may be able to tolerate higher MHD serum levels (p = 0.006) and higher OXC dosages per body weight (p < 0.001) compared to adult patients (≥ 18 years). Furthermore, AEs occurred at higher body-weight adjusted OXC dosages of extended release formulations compared to immediate-release formulations (p = 0.010), whereas MHD serum levels at which AEs occurred did not differ significantly between formulations (p = 0.125). Multivariate GEE confirmed the results. CONCLUSION The occurrence of AEs is significantly (and non-linearly) dependent on MHD serum level, whereas the dependence of OXC dosage is less distinctive. But, tolerability of OXC seems to depend on age of the patients as well as on pharmaceutical formulation of OXC.
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Affiliation(s)
- Annika Sattler
- Epilepsiezentrum Bethel, Krankenhaus Mara gGmbH, D-33617 Bielefeld, Germany; Charité Universitätsmedizin Berlin, Institut für klinische Pharmakologie, D-10115 Berlin, Germany
| | - Marion Schaefer
- Charité Universitätsmedizin Berlin, Institut für klinische Pharmakologie, D-10115 Berlin, Germany
| | - Theodor W May
- Gesellschaft für Epilepsieforschung, D-33617 Bielefeld, Germany.
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Steinhoff B. Antikonvulsive Pharmakotherapie Jugendlicher und Erwachsener. ZEITSCHRIFT FUR EPILEPTOLOGIE 2013. [DOI: 10.1007/s10309-013-0307-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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