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Stern S, Weingarten M, Mandapati S, Ferrari L, Wade CT. Real-world analysis of retention on cenobamate in patients with epilepsy in the United States. Epilepsy Res 2023; 197:107207. [PMID: 37741165 DOI: 10.1016/j.eplepsyres.2023.107207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND This retrospective, observational study used US claims data to assess retention rates on cenobamate compared with four branded antiseizure medications (ASMs) in patients with epilepsy. METHODS Adults (≥18 years) with prevalent epilepsy (ICD-10 code G40.xx) and ≥ 1 prescription for cenobamate or any of the newer branded ASMs (brivaracetam, eslicarbazepine, lacosamide, or perampanel) between May 1, 2020 and December 31, 2021 were identified from the HealthVerity Marketplace database. At least 360 days of continuous enrollment was required before and after the index date (Day 1 of initiating cenobamate or branded ASM). Patients were followed until cessation of cenobamate or branded ASM or the end of data collection using Kaplan-Meier methods. Retention was compared between cenobamate and the branded ASMs (both as a group and individually) using Chi-square tests. RESULTS In total, 4109 patients were included (195 cenobamate; 3914 branded ASMs). A higher proportion of patients in the cenobamate group compared with the branded ASMs group had concurrent focal and generalized epilepsy (65.6% vs 40.0%) and were on ≥ 3 concomitant ASMs (48.2% vs 12.8%) at the index date. Median time to discontinuation (i.e., the time that half the patients discontinued) was not quite reached after 12 months in the cenobamate group (50.3% of patients remained on cenobamate) and was 7.7 months in the branded ASMs group. Retention was significantly higher with cenobamate vs the branded ASMs group (p = 0.04545) and vs the individual ASMs lacosamide (p = 0.03044) and perampanel (p = 0.01558). Twelve-month retention rates (95% confidence intervals) were 50.3% (43.1%-57.0%) for cenobamate, 40.5% (38.9%-42.0%) for branded ASMs overall, 42.3% (38.6%-46.0%) for brivaracetam, 44.1% (39.2%-49.0%) for eslicarbazepine, 39.9% (38.0%-41.8%) for lacosamide, and 36.8% (31.9%-41.8%) for perampanel. CONCLUSIONS In this real-world analysis, retention was significantly higher with cenobamate vs a pooled group of four branded ASMs despite a greater frequency of patients in the cenobamate group having characteristics of more difficult-to-treat epilepsy.
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Affiliation(s)
- Sean Stern
- SK Life Science, Inc., Paramus, NJ, USA.
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Efficacy, tolerability and pharmacokinetic variability of brivaracetam in adults with difficult-to-treat epilepsy. Epilepsy Res 2022; 183:106946. [DOI: 10.1016/j.eplepsyres.2022.106946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022]
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de Toledo M, Valladares-Salado L, Cebrian-Escudero J, Diaz-Perez C, de la Fuente E, Ferreiros R, Sanz-Sanz E, Vega-Piris L, Lagares A, Ovejero-Benito MC, Sobrado M. Pharmacokinetic variability of eslicarbazepine in real clinical practice. Epilepsy Behav 2021; 124:108284. [PMID: 34521058 DOI: 10.1016/j.yebeh.2021.108284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Eslicarbazepine acetate (ESL) is a sodium channel blocker indicated for partial-onset seizures with or without secondary generalization, at a single daily dose. There are very few publications on the levels of ESL metabolites in real clinical practice. OBJECTIVE To describe the serum levels of licarbazepine (main metabolite of ESL) in patients with refractory epilepsy in real clinical practice. To evaluate the influence of age, sex, and polytherapy on levels and adverse effects. METHODS This study involved a retrospective analysis of patients diagnosed with epilepsy treated with ESL for whom plasma levels of licarbazepine were available, measured by spectrophotometry. RESULTS Sixty-four patients were included. One patient had licarbazepine levels of 0 (admitted not taking the drug) was not analyzed. Mean licarbazepine levels of 7.66 µg/mL (400 mg/day dose), 16.56 µg/mL (800-mg dose), and 20.80 µg/mL (1200 mg) were significantly different. There was a significant correlation between daily dose and serum levels (p < 0.05) and between the concentration/dose ratio and lower to higher doses (p < 0.05). Pharmacokinetic variability (coefficient of variation for the concentration/dose ratio) was 33.2%. We found a decrease in the concentration/dose ratio in the 1200 mg/day dose, compared to lower doses. We did not find differences by sex or intake of other antiepileptic inducers or metabolic inhibitors. Fifteen patients (23.8%) had mild nonsymptomatic hyponatremia. CONCLUSION These results suggest that it is not necessary to routinely determine licarbazepine levels. In specific cases, licarbazepine levels can be useful to assess adherence to treatment and for personalized dose adjustment.
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Affiliation(s)
- Maria de Toledo
- Epilepsy Unit, Department of Neurology, Instituto de Investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain.
| | - Laura Valladares-Salado
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Jose Cebrian-Escudero
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Carolina Diaz-Perez
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Elisa de la Fuente
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Raquel Ferreiros
- Department of Clinical Laboratory Analysis, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Elena Sanz-Sanz
- Department of Clinical Laboratory Analysis, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Lorena Vega-Piris
- Methodologic Unit, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense Madrid, Instituto de Investigación i+12 CIBERESP, Spain
| | - Maria C Ovejero-Benito
- Clinical Pharmacology Unit, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain. Departamento de Ciencias Farmaceuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanizacion Monteprincipe, 28925, Alcorcon, Madrid, Spain
| | - Monica Sobrado
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
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Lossius IMB, Svendsen T, Sødal HF, Kjeldstadli K, Lossius MI, Nakken KO, Johannessen Landmark C. Effect and tolerability of perampanel in patients with drug-resistant epilepsy. Epilepsy Behav 2021; 119:107965. [PMID: 33940525 DOI: 10.1016/j.yebeh.2021.107965] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Perampanel is one of the most recently approved antiseizure medications. The aim of the present study was to assess clinical efficacy and tolerability, in combination with pharmacokinetic variability, of perampanel treatment in patients at a tertiary referral center for epilepsy. METHODS We performed a retrospective observational study of patients given perampanel as adjunctive treatment in the period January 2013 - February 2019 at the National Center for Epilepsy at Oslo University Hospital, Norway. RESULTS Clinical data were available for 175 mainly adult patients with drug-resistant epilepsy with mean treatment duration of 16.1 months. We found that 23% (40 patients) were responders (i.e., achieving more than 50% reduction in seizure frequency), four of whom became seizure free, 29% (51 patients) experienced a modest effect, whereas for 29% (50 patients) perampanel had no seizure-reducing effect. A paradoxical effect, with seizure aggravation, was reported in 9% (15 patients). The responder rate was significantly higher in those with slow vs. fast dosage titration. Logistic regression analysis showed better efficacy among those with generalized vs. those with focal epilepsy. Adverse effects were reported by 135 patients (77%), ranging from mild (34%), to moderate (41%) and severe (2%). In 55 patients (41%), these adverse effects resulted in discontinuation of treatment with perampanel. The most frequent adverse effects were psychiatric symptoms (34%), dizziness (31%), and sleepiness (26%). Of the 31 patients for whom serum concentration measurements were available, the mean daily perampanel dose was 6.3 mg (SD 3.0), with a mean serum concentration at steady state of 1.03 μmol/L (range: 0.15-3.59 μmol/L). There were pronounced differences between patients, as demonstrated by a 12-fold variability in the range of concentration/dose (C/D)-ratios (0.06 to 0.69 μmol/L/mg), where enzyme inducers contributed. CONCLUSION Our results demonstrate that perampanel had a modest seizure-reducing effect in this very treatment-resistant patient group. Predictors of treatment success were generalized epilepsy and slow dosage titration. In patients without a history of psychiatric problems, clinicians could consider increasing dose of perampanel beyond 6 mg daily, taking co-medication and serum concentrations into account.
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Affiliation(s)
| | - Torleiv Svendsen
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway.
| | - Hild F Sødal
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kari Kjeldstadli
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Morten Ingvar Lossius
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; University of Oslo University, Norway
| | - Karl Otto Nakken
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway
| | - Cecile Johannessen Landmark
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway; Program for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Hirosawa K, Fukami T, Tashiro K, Sakai Y, Kisui F, Nakano M, Nakajima M. Role of Human Arylacetamide Deacetylase (AADAC) on Hydrolysis of Eslicarbazepine Acetate and Effects of AADAC Genetic Polymorphisms on Hydrolase Activity. Drug Metab Dispos 2021; 49:322-329. [DOI: 10.1124/dmd.120.000295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022] Open
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Roberti R, Palleria C, Nesci V, Tallarico M, Di Bonaventura C, Cerulli Irelli E, Morano A, De Sarro G, Russo E, Citraro R. Pharmacokinetic considerations about antiseizure medications in the elderly. Expert Opin Drug Metab Toxicol 2020; 16:983-995. [DOI: 10.1080/17425255.2020.1806236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Valentina Nesci
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Martina Tallarico
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Human Neurosciences, “Sapienza” University, Rome, Italy
| | | | - Alessandra Morano
- Neurology Unit, Department of Human Neurosciences, “Sapienza” University, Rome, Italy
| | | | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
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Svendsen T, Brodtkorb E, Baftiu A, Lossius MI, Nakken KO, Johannessen SI, Johannessen Landmark C. Clinical experience combined with therapeutic drug monitoring of lacosamide. Acta Neurol Scand 2020; 141:279-286. [PMID: 31853958 DOI: 10.1111/ane.13206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Lacosamide (LCM) is an antiepileptic drug (AED) with insufficient clinical experience in patients with intellectual disability (ID). They often have more severe epilepsy with comorbidities. The objective was to evaluate the efficacy and tolerability of lacosamide (LCM) in patients with refractory epilepsy with and without ID in a real-life setting, taking drug monitoring (TDM) data into account therapeutic. METHODS Retrospectively, we identified 344 patients using LCM from the TDM service covering the majority of the country, at the National Center for Epilepsy in Norway (2013-2018). Clinical and TDM data were available for 132 patients. RESULTS Forty-four of the 132 patients (33%) had ID. The retention rate was significantly higher in the ID vs the non-ID group after 1 year (84% vs 68%, P < .05). By combining clinical and TDM data, we demonstrated that 37/38 responding patients had serum concentrations above the lower limit of the reference range (>10 µmol/L), and 16/17 with lower concentrations were non-responders. Mean serum concentration/dose ratios were similar in both groups, 0.06 and 0.07 µmol/L/mg. There were no significant differences regarding efficacy and tolerability. The risk of LCM withdrawal was significantly higher when LCM was added to sodium channel blockers, even if the latter was discontinued. SIGNIFICANCE Lacosamide was generally well tolerated in patients with drug-resistant epilepsy, where one third had ID, and in these patients the retention rate was higher. The combination of clinical and TDM data could possibly facilitate LCM therapy in these vulnerable patients.
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Affiliation(s)
- Torleiv Svendsen
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Department of Neurology Innlandet Hospital Trust Lillehammer Norway
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology St. Olav's University Hospital Trondheim Norway
- Department of Neuroscience Norwegian University of Science and Technology Trondheim Norway
| | - Arton Baftiu
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- The Norwegian Medicines Agency Oslo Norway
| | - Morten I. Lossius
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Oslo University Oslo Norway
| | - Karl O. Nakken
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
| | - Svein I. Johannessen
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Program for Pharmacy Department of Life Sciences and Health Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Cecilie Johannessen Landmark
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Program for Pharmacy Department of Life Sciences and Health Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
- Section for Clinical Pharmacology Department of Pharmacology Oslo University Hospital Oslo Norway
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Johannessen Landmark C, Johannessen SI, Patsalos PN. Therapeutic drug monitoring of antiepileptic drugs: current status and future prospects. Expert Opin Drug Metab Toxicol 2020; 16:227-238. [DOI: 10.1080/17425255.2020.1724956] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Cecilie Johannessen Landmark
- Program for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Svein I. Johannessen
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Philip N. Patsalos
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
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Wechsler RT, Radtke RA, Smith M, Vossler DG, Strom L, Trinka E, Cheng H, Grinnell T, Blum D, Vieira M, Moreira J, Rocha F. Serum sodium levels and related treatment-emergent adverse events during eslicarbazepine acetate use in adults with epilepsy. Epilepsia 2019; 60:1341-1352. [PMID: 31260089 PMCID: PMC6852335 DOI: 10.1111/epi.16069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022]
Abstract
Objective To examine the frequency of hyponatremia and potentially related symptoms in clinical trials of eslicarbazepine acetate (ESL) in adults with focal‐ (partial‐) onset seizures. Methods This post hoc, exploratory analysis included data from three controlled phase 3 trials of adjunctive ESL (400‐1200 mg once daily), two phase 3 trials of ESL monotherapy (1200‐1600 mg once daily), and their open‐label extension studies. Exploratory endpoints included clinical laboratory measurements of serum sodium concentrations ([Na+]), incidences of hyponatremia‐related treatment‐emergent adverse events (TEAEs), and incidences of TEAEs that are potential symptoms of hyponatremia. Results The controlled trials of adjunctive ESL and ESL monotherapy included 1447 (placebo, n = 426; ESL, n = 1021) and 365 (ESL, n = 365) patients, respectively; 639 and 274 patients continued onto uncontrolled, open‐label extensions. In the controlled and uncontrolled trials ≤3.3% of patients taking ESL had a minimum postdose [Na+] measurement ≤125 mEq/L, <9% had a >10 mEq/L decrease in [Na+] from baseline, <6% had a hyponatremia‐related TEAE, and <2% discontinued the controlled trials due to a hyponatremia‐related TEAE. Hyponatremia appeared to be more frequent in the monotherapy (vs adjunctive therapy) trials; in the controlled trials of adjunctive ESL and ESL monotherapy, incidence generally increased with increasing ESL dose. The majority of patients with an investigator‐reported TEAE of “hyponatremia” or “blood sodium decreased” did not have a corresponding laboratory [Na+] measurement ≤125 mEq/L. Some symptoms potentially related to hyponatremia (including nausea and vomiting) were more frequent in patients with a minimum postdose [Na+] measurement ≤125 mEq/L. Significance Reductions in serum sodium concentrations and hyponatremia‐related TEAEs occurred in a small number of patients taking ESL. Suspected hyponatremia should be confirmed and monitored via [Na+] measurements.
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Affiliation(s)
| | | | | | - David G Vossler
- University of Washington, Valley Medical Center, Renton, Washington
| | - Laura Strom
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eugen Trinka
- Uniklinikum Salzburg, Christian-Doppler-Klinik, Salzburg, Austria
| | - Hailong Cheng
- Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts
| | - Todd Grinnell
- Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts
| | - David Blum
- Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts
| | - Mariana Vieira
- BIAL - Portela & Cª., S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - Joana Moreira
- BIAL - Portela & Cª., S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - Francisco Rocha
- BIAL - Portela & Cª., S.A., Coronado (S. Romão e S. Mamede), Portugal
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Pharmacokinetic Factors to Consider in the Selection of Antiseizure Drugs for Older Patients with Epilepsy. Drugs Aging 2018; 35:687-698. [DOI: 10.1007/s40266-018-0562-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Galiana GL, Gauthier AC, Mattson RH. Eslicarbazepine Acetate: A New Improvement on a Classic Drug Family for the Treatment of Partial-Onset Seizures. Drugs R D 2018; 17:329-339. [PMID: 28741150 PMCID: PMC5629137 DOI: 10.1007/s40268-017-0197-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Eslicarbazepine acetate is a new anti-epileptic drug belonging to the dibenzazepine carboxamide family that is currently approved as adjunctive therapy and monotherapy for partial-onset (focal) seizures. The drug enhances slow inactivation of voltage-gated sodium channels and subsequently reduces the activity of rapidly firing neurons. Eslicarbazepine acetate has few, but some, drug–drug interactions. It is a weak enzyme inducer and it inhibits cytochrome P450 2C19, but it affects a smaller assortment of enzymes than carbamazepine. Clinical studies using eslicarbazepine acetate as adjunctive treatment or monotherapy have demonstrated its efficacy in patients with refractory or newly diagnosed focal seizures. The drug is generally well tolerated, and the most common side effects include dizziness, headache, and diplopia. One of the greatest strengths of eslicarbazepine acetate is its ability to be administered only once per day. Eslicarbazepine acetate has many advantages over older anti-epileptic drugs, and it should be strongly considered when treating patients with partial-onset epilepsy.
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Affiliation(s)
- Graciana L Galiana
- Department of Neurology, Yale Comprehensive Epilepsy Center, Yale School of Medicine, PO Box 208018, New Haven, CT, 06520, USA
| | - Angela C Gauthier
- Department of Neurology, Yale Comprehensive Epilepsy Center, Yale School of Medicine, PO Box 208018, New Haven, CT, 06520, USA.
| | - Richard H Mattson
- Department of Neurology, Yale Comprehensive Epilepsy Center, Yale School of Medicine, PO Box 208018, New Haven, CT, 06520, USA
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Reimers A, Berg JA, Burns ML, Brodtkorb E, Johannessen SI, Johannessen Landmark C. Reference ranges for antiepileptic drugs revisited: a practical approach to establish national guidelines. Drug Des Devel Ther 2018; 12:271-280. [PMID: 29467570 PMCID: PMC5811172 DOI: 10.2147/dddt.s154388] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Laboratories sometimes use different reference ranges for the same antiepileptic drug (AED), particularly for new and poorly investigated drugs. This may contribute to misunderstandings, concerns or inappropriate dose changes, which in turn may affect therapeutic effect, drug safety or treatment adherence. Therefore, the Norwegian Association of Clinical Pharmacology wished to update and harmonize the reference ranges for AEDs and establish national guidelines for Norway. METHODS A working group collected information on the reference ranges used by Norwegian laboratories for all commonly used AEDs. These reference ranges were compared to recent recommendations by the International League Against Epilepsy, current literature, applicable clinical studies, reference ranges used by leading Northern European epilepsy centers outside of Norway, and routine data derived from Norwegian laboratory databases. RESULTS Reference ranges varied between laboratories for four of 23 available AEDs (lamotrigine, valproate, eslicarbazepine and oxcarbazepine). For four AEDs (brivaracetam, perampanel, stiripentol and sulthiame), reference ranges had not previously been established. In total, 13 reference ranges were either harmonized, updated or newly established. No changes were applied to the remaining 10 AEDs. CONCLUSION Updated and harmonized reference ranges are now available for 22 of the 23 AEDs available in Norway. The exception is vigabatrin (reference range not applicable). Revision of reference ranges is an important part of pharmacovigilance of AEDs and must be a continuous process based on current literature and clinical experience.
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Affiliation(s)
- Arne Reimers
- Department of Clinical Pharmacology, St Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jon Andsnes Berg
- Laboratory of Clinical Biochemistry, Section of Clinical Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Margrete Larsen Burns
- Department of Pharmacology, Section for Clinical Pharmacology, The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein I Johannessen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Cecilie Johannessen Landmark
- Department of Pharmacology, Section for Clinical Pharmacology, The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
- The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
- Programme for Pharmacy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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