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Molimard A, Foissac F, Bouazza N, Gana I, Benaboud S, Froelicher L, Hirt D, Urien S, Desguerre I, Treluyer JM, Chemaly N, Nabbout R. Optimization of vigabatrin dosage in children with epileptic spasms: A population pharmacokinetic approach. Br J Clin Pharmacol 2024; 90:1900-1910. [PMID: 38664899 DOI: 10.1111/bcp.16072] [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: 08/30/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Vigabatrin is an antiepileptic drug used to treat some forms of severe epilepsy in children. The main adverse effect is ocular toxicity, which is related to the cumulative dose. The aim of the study is to identify an acceptable exposure range, both through the development of a population pharmacokinetic model of vigabatrin in children enabling us to calculate patient exposure and through the study of therapeutic response. METHODS We performed a retrospective study including children with epilepsy followed at Necker-Enfants Malades hospital who had a vigabatrin assay between January 2019 and January 2022. The population pharmacokinetic study was performed on Monolix2021 using a nonlinear mixed-effects modelling approach. Children treated for epileptic spasms were classified into responder and nonresponder groups according to whether the spasms resolved, in order to identify an effective plasma exposure range. RESULTS We included 79 patients and analysed 159 samples. The median age was 4.2 years (range 0.3-18). A 2-compartment model with allometry and creatinine clearance on clearance best fit our data. Exposure analysis was performed on 61 patients with epileptic spasms. Of the 22 patients who responded (36%), 95% had an AUC0-24 between 264 and 549 mg.h.L-1. CONCLUSIONS The population pharmacokinetic model allowed us to identify bodyweight and creatinine clearance as the 2 main factors explaining the observed interindividual variability of vigabatrin. An acceptable exposure range was defined in this study. A target concentration intervention approach using this pharmacokinetic model could be used to avoid overexposure in responder patients.
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Affiliation(s)
- Agathe Molimard
- Service de Neuropédiatrie et Maladies Métaboliques, Hôpital Necker-Enfants-malades, AP-HP, Université Paris Cité, Paris, France
| | - Frantz Foissac
- EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de recherche Clinique, Necker-Cochin, AP-HP, Paris, France
| | - Naïm Bouazza
- EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de recherche Clinique, Necker-Cochin, AP-HP, Paris, France
| | - Inès Gana
- Unité de recherche Clinique, Necker-Cochin, AP-HP, Paris, France
| | - Sihem Benaboud
- EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Service de pharmacologie clinique, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Léo Froelicher
- EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Service de pharmacologie clinique, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Déborah Hirt
- EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Service de pharmacologie clinique, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Saïk Urien
- Unité de recherche Clinique, Necker-Cochin, AP-HP, Paris, France
| | - Isabelle Desguerre
- Service de Neuropédiatrie et Maladies Métaboliques, Hôpital Necker-Enfants-malades, AP-HP, Université Paris Cité, Paris, France
| | - Jean-Marc Treluyer
- EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de recherche Clinique, Necker-Cochin, AP-HP, Paris, France
- Service de pharmacologie clinique, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Nicole Chemaly
- Service de Neuropédiatrie et Maladies Métaboliques, Hôpital Necker-Enfants-malades, AP-HP, Université Paris Cité, Paris, France
- Service de Neurologie pédiatrique, Centre de Reference Epilepsies Rares, Hôpital Necker-Enfants-malades, APHP, Inserm U1129, Imagine Institute, Université Paris Cité, Paris, France
| | - Rima Nabbout
- Service de Neuropédiatrie et Maladies Métaboliques, Hôpital Necker-Enfants-malades, AP-HP, Université Paris Cité, Paris, France
- Service de Neurologie pédiatrique, Centre de Reference Epilepsies Rares, Hôpital Necker-Enfants-malades, APHP, Inserm U1129, Imagine Institute, Université Paris Cité, Paris, France
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Kuchenbuch M, Lo Barco T, Chemaly N, Chiron C, Nabbout R. Fifteen years of real-world data on the use of vigabatrin in individuals with infantile epileptic spasms syndrome. Epilepsia 2024; 65:430-444. [PMID: 37872396 DOI: 10.1111/epi.17808] [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: 03/17/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate our treatment algorithm for infantile epileptic spasms syndrome (IESS) used between 2000 and 2018. We initiated vigabatrin (VGB), and steroids were added if the electroclinical response (spasms and electroencephalogram [EEG]) to VGB was not obtained or incomplete. METHODS Individuals with IESS treated with VGB were recruited from our hospital clinical data warehouse based on electronic health records (EHRs) generated since 2009 and containing relevant keywords. We confirmed the diagnosis of IESS. Clinical, EEG, imaging, and biological data were extracted from the EHRs. We analyzed factors associated with short-term response, time to response, relapse, time to relapse of spasms, and the presence of spasms at last follow-up. RESULTS We collected data from 198 individuals (female: 46.5%, IESS onset: 6 [4.5-10.3] months, follow-up: 4.6 [2.5-7.6] years, median [Q1-Q3]) including 129 (65.2%) with identifiable etiology. VGB was started 17 (5-57.5) days after IESS diagnosis. A total of 113 individuals were responders (57.1% of the cohort), 64 with VGB alone and 38 with VGB further combined with steroids (56.6% and 33.6% of responders, respectively). Among responders, 33 (29%) experienced relapses of spasms, mostly those with later onset of spasms (p = .002) and those who received VGB for <24 months after spasms cessation compared to a longer duration on VGB (45% vs. 12.8%, p = .003). At follow-up, 92 individuals were seizure-free (46.5% of the whole cohort), including 26 free of therapy (13.1%). One hundred twelve individuals (56.6%) were still receiving VGB, with a duration of 3.2 (1.75-5.7) years. SIGNIFICANCE Our sequential protocol introducing VGB then adding steroids is an effective alternative to a combined VGB-steroids approach in IESS. It avoids steroid-related adverse events, as well as those from VGB-steroid combination. According to our data, a period of 7 days seems sufficient to assess VGB response and enables the addition of steroids rapidly if needed. Continuing VGB for 2 years may balance the risk of relapse and treatment-induced adverse events.
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Affiliation(s)
- Mathieu Kuchenbuch
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Service de Pédiatrie, Reference Center for Rare Epilepsies, member of ERN EpiCARE, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Tommaso Lo Barco
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Nicole Chemaly
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
| | - Catherine Chiron
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Université de Paris Cité, Paris, France
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Somisetty S, Santina A, Sarraf D, Mieler WF. The Impact of Systemic Medications on Retinal Function. Asia Pac J Ophthalmol (Phila) 2023; 12:115-157. [PMID: 36971705 DOI: 10.1097/apo.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023] Open
Abstract
This study will provide a thorough review of systemic (and select intravitreal) medications, along with illicit drugs that are capable of causing various patterns of retinal toxicity. The diagnosis is established by taking a thorough medication and drug history, and then by pattern recognition of the clinical retinal changes and multimodal imaging features. Examples of all of these types of toxicity will be thoroughly reviewed, including agents that cause retinal pigment epithelial disruption (hydroxychloroquine, thioridazine, pentosan polysulfate sodium, dideoxyinosine), retinal vascular occlusion (quinine, oral contraceptives), cystoid macular edema/retinal edema (nicotinic acid, sulfa-containing medications, taxels, glitazones), crystalline deposition (tamoxifen, canthaxanthin, methoxyflurane), uveitis, miscellaneous, and subjective visual symptoms (digoxin, sildenafil). The impact of newer chemotherapeutics and immunotherapeutics (tyrosine kinase inhibitor, mitogen-activated protein kinase kinase, checkpoint, anaplastic lymphoma kinase, extracellular signal-regulated kinase inhibitors, and others), will also be thoroughly reviewed. The mechanism of action will be explored in detail when known. When applicable, preventive measures will be discussed, and treatment will be reviewed. Illicit drugs (cannabinoids, cocaine, heroin, methamphetamine, alkyl nitrite), will also be reviewed in terms of the potential impact on retinal function.
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Affiliation(s)
- Swathi Somisetty
- Jules Stein Eye Institute, University of California, Los Angeles, CA
| | - Ahmad Santina
- Jules Stein Eye Institute, University of California, Los Angeles, CA
| | - David Sarraf
- Jules Stein Eye Institute, University of California, Los Angeles, CA
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