1
|
Piorczynski TB, Calixto J, Henry HC, England K, Cowley S, Hansen JM, Hill JT, Hansen JM. Valproic Acid Causes Redox-Regulated Post-Translational Protein Modifications That Are Dependent upon P19 Cellular Differentiation States. Antioxidants (Basel) 2024; 13:560. [PMID: 38790665 PMCID: PMC11117966 DOI: 10.3390/antiox13050560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
Valproic acid (VPA) is a common anti-epileptic drug and known neurodevelopmental toxicant. Although the exact mechanism of VPA toxicity remains unknown, recent findings show that VPA disrupts redox signaling in undifferentiated cells but has little effect on fully differentiated neurons. Redox imbalances often alter oxidative post-translational protein modifications and could affect embryogenesis if developmentally critical proteins are targeted. We hypothesize that VPA causes redox-sensitive post-translational protein modifications that are dependent upon cellular differentiation states. Undifferentiated P19 cells and P19-derived neurons were treated with VPA alone or pretreated with D3T, an inducer of the nuclear factor erythroid 2-related factor 2 (NRF2) antioxidant pathway, prior to VPA exposure. Undifferentiated cells treated with VPA alone exhibited an oxidized glutathione redox couple and increased overall protein oxidation, whereas differentiated neurons were protected from protein oxidation via increased S-glutathionylation. Pretreatment with D3T prevented the effects of VPA exposure in undifferentiated cells. Taken together, our findings support redox-sensitive post-translational protein alterations in undifferentiated cells as a mechanism of VPA-induced developmental toxicity and propose NRF2 activation as a means to preserve proper neurogenesis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jason M. Hansen
- Department of Cell Biology and Physiology, Brigham Young University, Provo, UT 84602, USA; (T.B.P.); (J.C.); (H.C.H.); (K.E.); (S.C.); (J.M.H.); (J.T.H.)
| |
Collapse
|
2
|
Wójcik K, Kruk M, Koń B, Słowik A, Bosak M. Treatment patterns in women of childbearing age and pregnant women with epilepsy in Poland between the years 2019 and 2022-A nationwide population-based cohort study. Seizure 2024; 115:75-80. [PMID: 38232647 DOI: 10.1016/j.seizure.2024.01.007] [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: 11/01/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
AIM To describe the antiseizure medications (ASMs) prescription pattern in women of childbearing age (WOCA) and pregnant women with epilepsy in the 2019-2022 period in Poland MATERIALS AND METHODS: The National Health Fund (NHF) databases were analyzed. Women aged 15-49 years were considered as being of childbearing age, while exposure during pregnancy was estimated taking into account 15 months before delivery. ASMs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System, reimbursed by NHF were analyzed. RESULTS During 2019, 36 784 WOCA and 921 pregnant women filled at least 1 ASM prescription. In 2022, these numbers were 32 304 and 594, respectively. Valproate was the most widely used ASM in WOCA (38.4 %) in 2019, followed by levetiracetam (35.6 %), lamotrigine (30.1 %), and carbamazepine (20.0 %). The percentage of ASM users decreased in 2022 for valproate (32.1 %; p < 0.001) and carbamazepine (17 %; p < 0.001) and increased for levetiracetam (40.8 %; p < 0.001) and lamotrigine (32.7 %; p < 0.001). In 2019 lamotrigine (42.1 %) and levetiracetam (41.5 %) were the most frequently prescribed ASMs to pregnant women. During the study period, a significant increase in prescriptions for levetiracetam was observed (49.5 %; p = 0.003). The proportion of ASMs exposed pregnancies declined for valproate (from 24.7 to 16 %; p < 0.001) and topiramate (from 6.6 to 3.2 %; p = 0.005). The percentage of polytherapy regimens remained stable over the years, both for WOCA (39 %) and pregnant women (32 %). CONCLUSION Despite the decline in valproate usage, the drug was still among the most commonly prescribed ASMs in women of childbearing age and pregnant women with epilepsy. The awareness of teratogenic risks and new treatment guidelines should be improved in Poland.
Collapse
Affiliation(s)
| | | | - Beata Koń
- National Health Fund, Warszawa, Poland
| | - Agnieszka Słowik
- Jagiellonian University, Medical College, Department of Neurology, Kraków, Poland
| | - Magdalena Bosak
- Jagiellonian University, Medical College, Department of Neurology, Kraków, Poland.
| |
Collapse
|
3
|
Rutkovska I, Seilis A, Neikena Z, Poplavska E. Impact of Risk Minimisation Measures on Valproate Use among Women of Reproductive Age in Latvia Between 2013 and 2020: A 7-Year Nationwide Prescription Database Study. Drugs Real World Outcomes 2023; 10:639-649. [PMID: 37821776 PMCID: PMC10730785 DOI: 10.1007/s40801-023-00394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND A relevant safety concern for the use of valproate (VPA) in women of reproductive age is its teratogenicity. In 2014 European Medicines Agency (EMA) introduced risk minimisation measures (RMMs) to reduce the VPA use by women of reproductive age, where the impact on VPA use was not as large as expected. In 2018, the EMA introduced additional RMMs, and it is essential to assess impact of these interventions. OBJECTIVE The objective of this study was to evaluate the impact of the EMA-published RMMs in 2014 and 2018 on the prevalence of VPA use and to describe trends in the prevalence rate and incidence proportion of VPA use in epilepsy, bipolar disorder and off-label indications in Latvia. METHODS This was a nationwide population-based study using a primary care prescription database. The study included women in age groups < 15, 15-49 and > 49 years and men in age group 15-49 years who have received VPA. This study assessed the prevalence rate and the incidence proportion of VPA use. The impact of RMMs on the two study intervention periods [fourth quarter (Q4) 2014 and Q4 2018] in men and women was evaluated using causal impact analysis. RESULTS In the study cohort, VPA use in women in the age group 15-49 years decreased after the first and second intervention periods, where after the first intervention period the relative reduction in prevalence of VPA consumption was -7.7 [95% confidence interval (CI) -10%, -5.1%] and after both study periods -6.4% (95% CI -11%, -1.5%). In girls < 15 years of age, valproate use decreased after both intervention periods, while in women > 49 years old VPA use increased. In men aged 15-49 years, an increase after the first period and a non-significant decrease after both intervention periods was observed. The prevalence of valproate use in girls < 15 years and women 15-49 years of age with bipolar disorder, epilepsy and off-label indications decreased per 1000 people during the study period. The incidence proportion of VPA use in women aged 15-49 years decreased each year since the beginning of the study period. CONCLUSIONS A statistically significant decrease in the prevalence of VPA use was identified among girls < 15 years and women 15-49 years of age. In Latvia, an overall good reaction to the EMA RMMs was observed. The effects go beyond the target population and affect the use of VPA in young girls as well.
Collapse
Affiliation(s)
- Ieva Rutkovska
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia.
- Department of Applied Pharmacy, Faculty of Pharmacy, Riga Stradins University, Konsula Street 21, Riga, 1007, Latvia.
| | - Andis Seilis
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia
| | - Zane Neikena
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia
| | - Elita Poplavska
- State Agency of Medicines of the Republic of Latvia, Jersikas Street 15, Riga, 1003, Latvia
- Department of Applied Pharmacy, Faculty of Pharmacy, Riga Stradins University, Konsula Street 21, Riga, 1007, Latvia
- Institute of Public Health, Riga Stradins University, Kronvalda bulvaris 9, Riga, 1010, Latvia
| |
Collapse
|
4
|
Wójcik K, Franciszek Kołek M, Dec-Ćwiek M, Słowik A, Bosak M. Trends in antiseizure medications utilization among women of childbearing age with epilepsy in Poland between 2015 and 2019. Epilepsy Behav 2023; 139:109091. [PMID: 36682232 DOI: 10.1016/j.yebeh.2023.109091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine trends in the use of antiseizure medications (ASMs) among women of childbearing age (WOCA) and girls aged 12-14 years with epilepsy between 2015 and 2019 in Poland. METHODS The study used data from the Pex database, which captures information on prescriptions dispensed from 85% of community pharmacies in Poland. The prescriptions issued by neurologists who provide epilepsy care in Poland were studied. Six of the most commonly prescribed ASMs were analyzed: carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, topiramate, and valproate. RESULTS The use of valproate and carbamazepine decreased in all age groups. Among the newer ASMs, the use of lamotrigine, levetiracetam, and topiramate increased and oxcarbazepine decreased significantly in WOCA. The only subgroup with statistically significant changes in all ASMs prescriptions were women aged 19-34 years. For girls aged 12-14 years, significant changes were found only for valproate and carbamazepine. In the last year of observation (2019) valproate and lamotrigine accounted for two-thirds of ASMs units prescribed to WOCA. Valproate accounted for half of the prescribed drug units in girls aged 12-14 years. The lowest rates of VPA prescriptions were found in women aged 19-34 years. CONCLUSIONS There is a change in prescribing habits in WOCA with epilepsy in Poland with trends toward using less teratogenic ASMs. However, many WOCAs are treated with valproate and topiramate despite their known teratogenicity risk. Valproate is still the most commonly prescribed ASM in WOCA and girls aged 12-14 years. Educational interventions for healthcare professionals are needed to improve prescribing practices in WOCA with epilepsy in Poland.
Collapse
Affiliation(s)
| | | | - Małgorzata Dec-Ćwiek
- University Hospital in Kraków, Poland; Jagiellonian University, Faculty of Medicine, Department of Neurology, Poland
| | - Agnieszka Słowik
- University Hospital in Kraków, Poland; Jagiellonian University, Faculty of Medicine, Department of Neurology, Poland
| | - Magdalena Bosak
- University Hospital in Kraków, Poland; Jagiellonian University, Faculty of Medicine, Department of Neurology, Poland.
| |
Collapse
|
5
|
Teesaar RL, Taba N, Rakitin A. Competency in the management of women of childbearing age with epilepsy among primary care and specialist doctors in Estonia. Epilepsy Behav Rep 2023; 22:100599. [PMID: 37092037 PMCID: PMC10120288 DOI: 10.1016/j.ebr.2023.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Although abundant new information has emerged in the last decade(s) on the management of women with epilepsy (WWE), whether said knowledge has reached clinical practice remains largely unknown. We assessed knowledge of this matter among primary care and specialist doctors in Estonia. Methods This study was conducted via an online questionnaire, which was used to explore healthcare specialists' awareness in five domains: pre-pregnancy counseling, contraception, side effects of antiseizure medications (ASMs), and the management of epilepsy during pregnancy and in the peri- and postpartum periods. Results The survey response rate was low - 8.14%. Knowledge of epilepsy management in WWE was inconsistent among different medical specialists. The median numbers of correctly answered questions among gynecologists, neurologists, and general practitioners were 7, 6.5, and 3 of 10, respectively. Gynecologists were more informed about appropriate contraceptive methods. Neurologists were more familiar with ASM side effects. General practitioners' knowledge level for this topic was low. Surprisingly, only 30.8% of general practitioners were aware of the high teratogenic potential of valproate. Conclusions We observed significant knowledge gaps regarding the optimal treatment of WWE of reproductive age. To improve epilepsy management, doctors' awareness of treatment considerations for this patient group needs to be increased.
Collapse
Affiliation(s)
- Ringo L. Teesaar
- Neurology Clinic, Tartu University Hospital, L. Puusepp Str, 8H, 50406 Tartu, Estonia
- Corresponding author.
| | - Nele Taba
- Estonian Genome Center, Institute of Genomics, University of Tartu, Riia Str, 23b, 51010 Tartu, Estonia
| | - Aleksei Rakitin
- Neurology Clinic, Tartu University Hospital, L. Puusepp Str, 8H, 50406 Tartu, Estonia
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepp Str, 8H, 50406 Tartu, Estonia
| |
Collapse
|
6
|
Hughes JE, Buckley N, Looney Y, Curran S, Mullooly M, Bennett K. Valproate utilisation trends among women of childbearing potential in Ireland between 2014 and 2019: A drug utilisation study using interrupted time series. Pharmacoepidemiol Drug Saf 2022; 31:661-669. [PMID: 35285110 PMCID: PMC9315025 DOI: 10.1002/pds.5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to examine trends in valproate use among women of childbearing potential (WCBP) aged 16-44 years in Ireland following two European-directed regulatory interventions in December 2014 and April 2018. METHODS This was a repeated cross-sectional study using monthly national pharmacy claims data, to examine trend changes in the prevalence of valproate use among WCBP pre and post two separate regulatory events in December 2014 and April 2018. Annual population estimates from the Central Statistics Office were used to calculate the prevalence rate per 1000 eligible women. Segmented regression analysis of interrupted time series with negative binomial regression was used to examine rates for WCBP aged 16-44 years, and by 10-year age groups. Prevalence ratios (PR) are presented with 95% confidence intervals (CIs). RESULTS Among WCBP aged 16-44 years, there was no statistically significant change in the month-to-month prevalence ratio in the post- compared to pre-December 2014 intervention period. A significant decline was, however, observed in the post-, compared to pre-April 2018 intervention period (PR = 0.998, [95% CIs: 0.996, 1.000]; p = 0.029). Among those aged 16-24 years, a significant decreasing trend in the month-to-month prevalence ratio was found in the post- compared to pre-December 2014 intervention period (PR = 0.991, [95% CIs: 0.984, 0.998];p <0.01). A marginal effect was observed in the post- compared to pre-April 2018 intervention period for those aged 25-34 years (PR = 0.996, [95% CIs: 0.992, 1.000]; p = 0.048). CONCLUSION Although no evidence of change was observed following the December 2014 intervention period, a significant decline in the prevalence ratio of valproate use was observed after the 2018 intervention, which may reflect the introduction of the most recent contraindication measures.
Collapse
Affiliation(s)
- John E. Hughes
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Niamh Buckley
- Health Products Regulatory AuthorityKevin O'Malley House, Earlsfort Centre, Earlsfort TerraceDublin 2Ireland
| | - Yvonne Looney
- Health Products Regulatory AuthorityKevin O'Malley House, Earlsfort Centre, Earlsfort TerraceDublin 2Ireland
| | - Sinead Curran
- Health Products Regulatory AuthorityKevin O'Malley House, Earlsfort Centre, Earlsfort TerraceDublin 2Ireland
| | - Maeve Mullooly
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Kathleen Bennett
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
- Data Science Centre, Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| |
Collapse
|
7
|
Degremont A, Kerbrat S, Balusson F, Jonville-Bera AP, Ringa V, Travers D, Tillaut H, Leray E, Oger E, Birben A, Polard E. Prescribing Trends for Valproate Among Pregnant Women: A Cross-sectional Study in 2013 and 2016 Using the French Health Insurance Database. Neurology 2022; 98:e2163-e2173. [PMID: 35379759 DOI: 10.1212/wnl.0000000000200260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to describe the prescribing trends for sodium valproate (VPA) and alternative drugs during and around pregnancy, comparing 2016 (after the recommendations on valproate for women were reinforced by the EMA) to 2013 (before the recommendations). METHODS Using the French National Health Insurance Database, a cross-sectional study was carried out in 2013 and in 2016, including women who became pregnant and had at least one reimbursement claim for VPA in the two years prior to pregnancy or during pregnancy. Exposure to VPA and its alternatives was then measured for each quarter, in the two years before pregnancy (pre-conception), during pregnancy and in the year after pregnancy (post-partum). RESULTS Among pregnant women with epilepsy (N=2,607 pregnancies), the proportion exposed to VPA during pregnancy decreased from 26.4% to 9.3% between 2013 and 2016, alongside an increase in lamotrigine and levetiracetam use. Among pregnant women with bipolar disorder (N=4,278 pregnancies), the proportion of women exposed during pregnancy decreased from 3.7% in 2013 to 1.9% in 2016, without any switch to alternative drugs. In both populations, less than one third had consulted a specialist before pregnancy. CONCLUSION As recommended by the EMA, a change in practice over the period 2013-2016 was observed, with fewer women exposed to VPA during pregnancy and before pregnancy. However, in 2016, a large number of women were exposed to VPA in the first trimester of pregnancy (N=471), which could suggest that the timing of pregnancy should be better planned whenever possible.
Collapse
Affiliation(s)
- Adeline Degremont
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France .,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Sandrine Kerbrat
- EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Frédéric Balusson
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Annie Pierre Jonville-Bera
- Pharmaco-vigilance and Drug Information Centre, Department of Pharmaco-surveillance, CHU de Tours, Tours, France
| | - Virginie Ringa
- INSERM CESP (Centre de recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Villejuif, France
| | - David Travers
- Department of Psychiatry, CHU de Rennes, Rennes, France
| | - Hélène Tillaut
- Department of Health Epidemiology and biostatistics for decision-making in public health, EHESP (School for Public Health), Rennes, France
| | - Emmanuelle Leray
- Department of Health Epidemiology and biostatistics for decision-making in public health, EHESP (School for Public Health), Rennes, France
| | - Emmanuel Oger
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| | - Arnaud Birben
- Epilepsy unit, Department of Neurology, CHU de Rennes, Rennes, France.,INSERM 1099, Signal and Image Processing Laboratory, Univ Rennes, Rennes, France
| | - Elisabeth Polard
- Pharmaco-vigilance, Pharmaco-epidemiology and Drug Information Centre, Department of Clinical Pharmacology, CHU de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmaco-epidemiology and Health Services Research', Univ Rennes, Rennes, France
| |
Collapse
|
8
|
Rakitin A, Kurvits K, Laius O, Uusküla M, Haldre S. Pre-pregnancy counseling for women with epilepsy: Can we do better? Epilepsy Behav 2021; 125:108404. [PMID: 34775248 DOI: 10.1016/j.yebeh.2021.108404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE For many women with epilepsy (WWE), decision making about pregnancy is difficult, due mainly to the potential teratogenic risks of anti-seizure medications (ASMs). Pre-pregnancy counseling is essential to minimize these risks. This study was conducted to assess the rate and effectiveness of pre-pregnancy counseling for women treated with valproate (VPA) in Estonia. METHODS We used outpatient prescription data from the national health insurance provider to identify all women treated with VPA during 2011-2018 in Estonia. The personal medical documentation of women who became pregnant while on VPA treatment was reviewed. Pre-pregnancy counseling history and VPA-treatment indications were analyzed. RESULTS Data from 141 women who became pregnant while on VPA treatment during 2011-2018 time period were analyzed. Of these patients, 77% had epilepsy and 19% psychiatric diagnoses. Pre-pregnancy counseling was recorded for 13% (n = 19) of women who later became pregnant. VPA monotherapy and the lack of VPA treatment indication were associated with the lack of counseling before pregnancy. CONCLUSIONS This study revealed a significant deficit in pre-pregnancy counseling for WWE treated with VPA in Estonia. Awareness of the need for such counseling should be increased among medical specialists.
Collapse
Affiliation(s)
- Aleksei Rakitin
- Department of Neurology and Neurosurgery, University of Tartu, Estonia; Neurology Clinic, Tartu University Hospital, Tartu, Estonia.
| | | | - Ott Laius
- Estonian State Agency of Medicines, Tartu, Estonia
| | - Maia Uusküla
- Estonian State Agency of Medicines, Tartu, Estonia
| | - Sulev Haldre
- Department of Neurology and Neurosurgery, University of Tartu, Estonia; Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| |
Collapse
|
9
|
Cardoso-Vera JD, Elizalde-Velázquez GA, Islas-Flores H, Mejía-García A, Ortega-Olvera JM, Gómez-Oliván LM. A review of antiepileptic drugs: Part 1 occurrence, fate in aquatic environments and removal during different treatment technologies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 768:145487. [PMID: 33736324 DOI: 10.1016/j.scitotenv.2021.145487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Antiepileptic drugs (AEDs) are the main treatment for people with epilepsy. However, in recent years, more and more people are using them for other indications such as: migraine, chronic neuropathic pain, and mood disorders. Consequently, the prescriptions and consumption of these drugs are increasing worldwide. In WWTPs, AEDs can resist degradation processes, such as photodegradation, chemical degradation and/or biodegradation. Until now, only constructed wetlands and photocatalysis have shown good removal rates of AEDs from wastewater. However, their effectiveness depends on the specific conditions used during the treatment. Since the consumption of AEDs has increased in the last decade and their degradation in WWTPs is poor, these drugs have been largely introduced into the environment through the discharge of municipal and/or hospital effluents. Once in the environment, AEDs are distributed in the water phase, as suspended particles or in the sediments, suggesting that these drugs have a high potential for groundwater contamination. In this first part of the AEDs review is designed to fill out the current knowledge gap about the occurrence, fate and removal of these drugs in the aquatic environment. This is a review that emphasizes the characteristics of AEDs as emerging contaminants.
Collapse
Affiliation(s)
- Jesús Daniel Cardoso-Vera
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Gustavo Axel Elizalde-Velázquez
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Hariz Islas-Flores
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Alejandro Mejía-García
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - José Mario Ortega-Olvera
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Leobardo Manuel Gómez-Oliván
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico.
| |
Collapse
|
10
|
Andersson K, Ozanne A, Bolin K, Tomson T, Zelano J. Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010-2015. Acta Neurol Scand 2021; 143:383-388. [PMID: 33523460 DOI: 10.1111/ane.13397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/19/2020] [Accepted: 01/15/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We investigated the correlation between socioeconomic status and the prescription of Valproic acid (VPA) in women of fertile age in Sweden. METHODS This is a registered-based cohort study including all women living in Sweden aged 18-45 years in the years 2010-2015, with a diagnosis of epilepsy and no intellectual disability (n = 9143). Data were collected from the National Patient Register, the Drug Prescription Register, and the Longitudinal integration database for health insurance and labor market studies (LISA). RESULTS Women with only 9 years of school were more often prescribed VPA than women with a University degree (12.9% compared to 10.7% in 2015 [p = 0.015]). Similar differences were seen between the lowest and highest income group (16.6% compared to 12.7% in 2015 [p < 0.001]). The odds of having a VPA prescription in 2015 was 1.59 (p < 0.001) in women with 9 years of school compared to women with a University degree, and 1.60 (p < 0.001) in the lowest income group relative to the highest income group after adjusting for age. From 2010 to 2015, the proportion with VPA prescription in the whole cohort diminished with an absolute reduction of -2.2% (p < 0.001). The decrease was similar among the different education and income groups (p = 0.919 and p = 0.280). SIGNIFICANCE The results indicate that the increased knowledge on VPA teratogenicity was implemented across socioeconomic strata in the Swedish healthcare system. Women with lower income or education level remained more frequent VPA users. Whether this difference reflects epilepsy type or severity, or socioeconomic disparities, merit further study.
Collapse
Affiliation(s)
- Klara Andersson
- Department of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristian Bolin
- Department of Economics, Gothenburg University, Gothenburg, Sweden
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Zelano
- Department of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
11
|
Asghar MA, Rehman AA, Raza ML, Shafiq Y, Asghar MA. Analysis of treatment adherence and cost among patients with epilepsy: a four-year retrospective cohort study in Pakistan. BMC Health Serv Res 2021; 21:72. [PMID: 33468110 PMCID: PMC7816349 DOI: 10.1186/s12913-021-06085-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/13/2021] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan. METHODS Data from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs. RESULTS A total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy. CONCLUSIONS Similar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.
Collapse
Affiliation(s)
- Muhammad Arif Asghar
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan.
| | - Ahad Abdul Rehman
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Muhammad Liaquat Raza
- Department of Pharmacology, Faculty of Pharmacy, Shaheed Benazir Bhutto Dewan University, Karachi, Pakistan.,Institute of Neurophysiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yousra Shafiq
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Muhammad Asif Asghar
- Food and Feed Safety Laboratory, Food and Marine Resources Research Centre, PCSIR Laboratories Complex, Shahrah-e-Salimuzzaman Siddiqui, Off University Road, 75280, Sindh, Pakistan
| |
Collapse
|
12
|
Rakitin A. Why Do Psychiatrists Still Prescribe Valproate to Women of Childbearing Potential? Front Psychiatry 2020; 11:739. [PMID: 32848919 PMCID: PMC7396713 DOI: 10.3389/fpsyt.2020.00739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aleksei Rakitin
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| |
Collapse
|