1
|
Zhou J, Wei Z, Chen S, Xie H, Huang W, Liu M, Wu X. Movement disorders associated with antiseizure medications: A real-world disproportionality analysis of the Food and Drug Administration Adverse Event Reporting System. Br J Clin Pharmacol 2023; 89:3389-3400. [PMID: 37353394 DOI: 10.1111/bcp.15836] [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: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023] Open
Abstract
AIMS Patients with epilepsy often require long-term use of antiseizure medications (ASMs) to control their seizures. However, movement disorders (MDs) related to ASMs can significantly impact their quality of life. This study aims to analyse MDs related to ASMs in the Food and Drug Administration Adverse Event Reporting System database to provide recommendations for safe medication. METHODS All adverse drug reactions associated with 26 marketed ASMs in Food and Drug Administration Adverse Event Reporting System were extracted for analysis. Disproportionality analyses were used to assess the association between ASMs and MDs, and signal colour scale maps were created to identify potential ASM-MD safety signals. RESULTS A total of 1921 cases experienced MDs while taking ASMs were included. A higher prevalence of MDs was observed in females compared to males. The association between specific MDs with ASMs was revealed, including known and unknown MDs such as tremors, Parkinson and paralysis. Lamotrigine and carbamazepine exhibited multiple significant MDs, while levetiracetam and pregabalin were linked to the earlier onset of MDs. Generally, higher doses were linked to a higher incidence of MDs. CONCLUSION MDs were the most obvious adverse drug reactions in the nervous system triggered by using ASMs. Fourteen drugs exhibited positive signals for MDs, including some not previously reported. Conversely, 12 ASMs were deemed to have a lower possibility of inducing MDs. The incidence of MDs can be mitigated by selecting appropriate ASMs for epileptic patients. These findings enhance our understanding of the relationship between ASMs and MDs.
Collapse
Affiliation(s)
- Jianxing Zhou
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Zipeng Wei
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Shengyang Chen
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Helin Xie
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wei Huang
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Maobai Liu
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| | - Xuemei Wu
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
2
|
Patel S, Moser A, Domingo H. Sustained virologic response in DAA-treated HCV patients on anti-epileptic drugs. J Hepatol 2023; 79:e121-e123. [PMID: 37271373 DOI: 10.1016/j.jhep.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
|
3
|
Nava FA, Mangia A, Riglietta M, Somaini L, Foschi FG, Claar E, Maida I, Ucciferri C, Frigerio F, Hernandez C, Dovizio M, Perrone V, Degli Esposti L, Puoti M. Analysis of Patients' Characteristics and Treatment Profile of People Who Use Drugs (PWUDs) with and without a Co-Diagnosis of Viral Hepatitis C: A Real-World Retrospective Italian Analysis. Ther Clin Risk Manag 2023; 19:645-656. [PMID: 37560130 PMCID: PMC10408688 DOI: 10.2147/tcrm.s409134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Hepatitis C virus (HCV) spreads from contact with blood of an infected person. HCV infections are common among people who use drugs (PWUDs), when sharing needles, syringes, or other equipment for injected drugs. The advent of pangenotypic direct-antiviral agents (DAA) in 2017 transformed the treatment landscape for HCV, but PWUDs remain a complex and hard-to-treat population with high risk of HCV reinfection. The aim of this real-world analysis was to characterize the demographic and clinical features of PWUDs in Italy, also focusing on comorbidity profile, treatment with DAAs, resource consumptions for the National Health System (NHS). PATIENTS AND METHODS During 01/2011-06/2020, administrative databases of Italian healthcare entities, covering 3,900,000 individuals, were browsed to identify PWUDs with or without HCV infection. Among HCV+ patients, a further stratification was made into treated and untreated with DAAs. The date of PWUD or HCV first diagnosis or DAA first prescription was considered as index-date. Patients were then followed-up for one year. Alcohol-dependency was also investigated. RESULTS Total 3690 PWUDs were included, of whom 1141 (30.9%) PWUD-HCV+ and 2549 (69.1%) PWUD-HCV-. HCV-positive were significantly older (43.6 vs 38.5 years, p < 0.001), had a worse comorbidity profile (Charlson-index: 0.8 vs 0.4, p < 0.001), and high rates of psychiatric, respiratory, dermatological, musculoskeletal diseases and genitourinary (sexually transmitted) infections. Moreover, they received more drug prescriptions (other than DAAs, like anti-acids, antiepileptics, psycholeptics) and had undergone more frequent hospitalization, predominantly for hepatobiliary, respiratory system and mental disorders. DDA-untreated had significantly higher Charlson-index than DAA-treated (0.9 vs 0.6, p = 0.003). Alcoholism was found in 436 (11.8%) cases. CONCLUSION This Italian real-world analysis suggests that PWUDs with HCV infection, especially those untreated with DAAs, show an elevated drug consumption due to their complex clinical profile. These findings could help to ameliorate the healthcare interventions on PWUDs with HCV infection.
Collapse
Affiliation(s)
- Felice Alfonso Nava
- U.O. Sanità Penitenziaria e Area Dipendenze, Azienda ULSS 6 Euganea, Padova, Italy
| | - Alessandra Mangia
- UOS Epatologia, Istituto di Ricovero e Cura “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | | | | | | | - Ernesto Claar
- UOC Medicina Interna, Ospedale Evangelico “Villa Betania”, Napoli, Italy
| | - Ivana Maida
- UOC Malattie Infettive e Parassitarie, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Claudio Ucciferri
- Clinica di Malattie Infettive Ospedale “SS Annunziata”, Chieti, Italy
| | | | - Candido Hernandez
- Gilead Sciences, Global Medical Affairs, Stockley Park, London, UB11 1BD, UK
| | - Melania Dovizio
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Massimo Puoti
- SC Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
4
|
Braude M, Ratnam DT, Marsh L, Abasszade JH, Dev AT. Hepatitis C virus treatment with glecaprevir and pibrentasvir in patients co-prescribed carbamazepine: Three case reports. World J Gastrointest Pharmacol Ther 2023; 14:33-38. [PMID: 37484883 PMCID: PMC10359723 DOI: 10.4292/wjgpt.v14.i4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Highly effective and well-tolerated direct-acting antiviral (DAA) therapies have revolutionised the management of hepatitis C virus (HCV); however, niche populations face treatment barriers. DAAs co-prescribed with several first-generation anti-epileptic drugs (AEDs) are contraindicated due to drug-drug interactions. A common example is carbamazepine whereby steady-state carbamazepine reduces the maximum concentration and area under the curve of velpatasvir, glecaprevir and pibrentasvir due to potent cytochrome P450 (CYP) 3A4 induction. Carbamazepine also induces P-glycoprotein which reduces glecaprevir and pibrentasvir’s area under curve to infinite time. Sofosbuvir-velpatasvir and glecaprevir-pibrentasvir are contraindicated in patients who are co-prescribed carbamazepine due to the risk of reduced DAA therapeutic effect and consequently, virological treatment failure. This presents a challenge for patients in whom carbamazepine substitution is medically unfeasible, impractical or unacceptable. However, the properties of current generation DAA therapies, including high-potency non-structural protein 5A inhibitory effect, may be sufficient to overcome reduced bioavailability arising from carbamazepine related CYP 3A4 and P-glycoprotein induction.
CASE SUMMARY We present a case series of three patients with non-cirrhotic, treatment-naïve, genotype 1a, 1b, and 3a HCV who were treated with a 12 wk course of glecaprevir-pibrentasvir, while co-prescribed carbamazepine for seizure disorders. Glecaprevir-pibrentasvir combination therapy was chosen due to its potent in vitro activity and low barrier to pan-genotypic resistance associated variants. DAA therapy was dose-separated from carbamazepine to maximise time to peak concentration, and taken with meals to improve absorption. Sustained virological response at 12 wk was achieved in each patient with no adverse outcomes.
CONCLUSION DAA therapies, including glecaprevir-pibrentasvir, warrant consideration as a therapeutic agent in people with HCV who are co-prescribed carbamazepine, particularly if AED substitution is not feasible.
Collapse
Affiliation(s)
- Michael Braude
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| | - Dilip T Ratnam
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| | - Louise Marsh
- General Practice, Margaret River Medical Centre, Margaret River 6285, Australia
| | - Joshua H Abasszade
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| | - Anouk T Dev
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, VIC, Australia
| |
Collapse
|
5
|
Burger D, Aktas H, de Knegt R. Sustained virological response in an HCV-infected patient on an enzyme-inducing anti-epileptic agent despite undetectable trough plasma levels of velpatasvir. J Hepatol 2023; 78:e175-e177. [PMID: 36708810 DOI: 10.1016/j.jhep.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Affiliation(s)
- David Burger
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), RadboudUMC, Nijmegen, the Netherlands.
| | - Huseyin Aktas
- Department of Gastroenterology & Hepatology, ZGT Hospital, Almelo, the Netherlands
| | - Robert de Knegt
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|