Adverse drug reactions associated with six commonly used antiepileptic drugs in southern China from 2003 to 2015

Du, Yukai; Lin, Jiahe; Shen, Jingzan; Ding, Siqi; Ye, Mengqian; Wang, Li; Wang, Yi; Wang, Xinshi; Zheng, Ran; Chen, Hong; Xu, Huiqin

doi:10.1186/s40360-019-0285-y

Cited by 26 publications

(19 citation statements)

References 30 publications

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“…Currently, antiepileptic drug (AED) therapy is the main treatment for epilepsy, and 65%‐85% of people with epilepsy (PWE) experience a long‐term seizure‐free period on medication . Nevertheless, nearly 60% of PWE experience adverse effects from AEDs that could result in a significant decline in the quality of life . In addition, PWE face a substantial economic burden because of the long‐term use of AEDs .…”

Section: Introductionmentioning

confidence: 99%

External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients

Lin

Ding

et al. 2019

Epilepsia

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Objective:The models currently available for predicting the risk of seizure recurrence after antiepileptic drug (AED) withdrawal in adult epilepsy patients include the prediction model developed by Lamberink et al (Lamberink model, 2017) and the Medical Research Council prediction model (MRC model, 1993). However, there was no external validation for the two models. The purpose of this study was to perform an independent external validation and a comparison of the Lamberink model and the MRC model in adult patients. Methods: The study population was recruited from the Wenzhou Epilepsy Follow-up Registry Database (WEFURD). All the predictors of the Lamberink and MRC models and the occurrence of seizure recurrence in the participants were collected based on the WEFURD. Participants' predicted probabilities of seizure recurrence were obtained by a Web-based tool and the prognostic index formula. The external validation of the Lamberink model and the MRC model were quantified by discrimination, calibration, and decision curve analysis (DCA). Results: Of 212 patients, 126 (59.4%) had seizure recurrence after AED withdrawal. The Lamberink 2-year model, the Lamberink 5-year model, the MRC 1-year model, and the MRC 2-year model had areas under the curve of 0.71 (95% confidence interval [CI] = 0.64-0.78), 0.68 (95% CI = 0.60-0.76), 0.60 (95% CI = 0.50-0.69), and 0.58 (95% CI = 0.50-0.66), respectively. Additionally, the Lamberink 2-year model had a significantly better integrated discrimination improvement than the MRC 2-year model (P < .001). Regarding calibration, the Lamberink 2-year model (P = .121) and the MRC 1-year model (P = .264) were well calibrated, but the Lamberink 5-year model (P = .022) and the MRC 2-year model (P = .008) were not. In the DCA, the Lamberink 2-year model performed well at threshold probabilities of 30%-65%. Significance: This external validation shows that the Lamberink 2-year model might be more accurate and has greater clinical benefit than others for guiding drug withdrawal in adult epilepsy clinics. 116 | LIN et aL. K E Y W O R D S adult epilepsy, drug withdrawal, external validation, prediction model, seizure recurrence Key Points • The Lamberink 2-year model had the highest AUC (0.71) among the models in the external validation • The Lamberink 2-year model (P = .121) and the MRC 1-year model (P = .264) were well calibrated, but the other prediction models were not • In the DCA, the Lamberink 2-year model performed well at threshold probabilities of 30%-65%

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Section: Introductionmentioning

confidence: 99%

External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients

Lin

Ding

et al. 2019

Epilepsia

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“…Considering that lower risks were associated with the use of LVT and TPM, which are both nonaromatic newer ASMs, the aromatic versus nonaromatic classification seems more important in predicting the development of SCARs due to ASMs compared to the old versus newer classification. Similarly, previous reports suggested that there is an increased risk of hypersensitivity when aromatic ASMs are used 3,7,18–20 . Aromatic ASMs commonly form metabolites known as “arene oxides,” and it has been hypothesized that this metabolite can act as a type of “hapten” that causes an immune response 3,18 .…”

Section: Discussionmentioning

confidence: 90%

“…However, ASMs cause adverse reactions in approximately 60% of the patients treated 3 . Specifically, aromatic ASMs are significantly associated with hypersensitive adverse reactions compared to nonaromatic ASMs 4 .…”

Section: Introductionmentioning

confidence: 99%

Incidence rates of severe cutaneous adverse reactions due to antiseizure medication: A nationwide study using health claims data in Korea

Chung

Ahn

et al. 2020

Epilepsia

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ObjectiveAntiseizure medications (ASMs) can rarely result in severe, sometimes fatal, cutaneous adverse reactions. To date, few studies have reported on the incidence rates (IRs) of severe cutaneous adverse reactions (SCARs) due to ASM use. This study aimed to determine the IRs of SCAR resulting from the use of seven commonly prescribed ASMs, carbamazepine (CBZ), phenytoin (PHT), oxcarbazepine (OXC), lamotrigine (LMT), zonisamide (ZNS), levetiracetam (LVT), and topiramate (TPM), and to compare the associated risks among the drugs.MethodsUsing a nationwide health claims database, we selected all the patients prescribed with one of the target ASMs. We defined a SCAR case as the first hospitalization with one of three specific codes provided by the International Classification of Diseases, 10th revision (L511, L512, and L27). We then calculated the IR of SCARs according to each target ASM.ResultsThe IR of SCARs for each ASM was as follows: 870/1 000 000 person‐years (PYs) for CBZ, 5750/1 000 000 PYs for PHT, 1490/1 000 000 PYs for OXC, 3860/1 000 000 PYs for LMT, 1540/1 000 000 PYs for ZNS, 830/1 000 000 PYs for LVT, and 400/1 000 000 PYs for TPM. Concomitant use of antibiotics and nonsteroidal anti‐inflammatory drugs significantly increased the risk of SCARs with OXC, LVT, or TPM use. Comorbid skin disease was associated with a significantly higher IR of SCARs from CBZ, PHT, OXC, LMT, or LVT use.SignificanceThis is the first study in Asia to determine the IRs of SCARs for various ASMs and compare the rates across drugs using a large dataset. The results from this study should help clinicians select safer ASMs in practice.

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“…Studies have shown that AEDs such as phenytoin and carbamazepine can only suppress the incidence of early PTE, but do not reduce the risk of late PTE, even during treatment [23, 24]. AEDs have some side effects, including psychiatric disorders, neurological disorders, gastrointestinal disorders, and skin and appendage disorders [25]. Nevertheless, due to the limitations of clinical treatment, AEDs remain the first choice for epilepsy treatment.…”

Section: Discussionmentioning

confidence: 99%

Auricular Electroacupuncture for Late Posttraumatic Epilepsy after Severe Brain Injury: A Retrospective Study

Shen

Jiang

2019

Evidence-Based Complementary and Alternative Medicine

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Background Posttraumatic epilepsy (PTE) is a common complication of traumatic brain injury (TBI), which seriously affects patients' survival and recovery. Vagus nerve stimulation (VNS) is a nonpharmacological therapy for epilepsy. The auricular branch of the vagus nerve (ABVN) is the only peripheral branch and has antiepileptic effects, but the efficacy of ABVN stimulation as treatment of late PTE is uncertain. We retrospectively analyzed the clinical efficacy of ABVN stimulation by auricular electroacupuncture for the treatment of late PTE, and investigated the influence of sodium valproate and edaravone on the anti-PTE effects of auricular electroacupuncture. Method Univariate and multivariate logistic regression analyses were used to investigate the relationship of age, cause of PTE, use of auricular electroacupuncture, sodium valproate, and edaravone with the incidence of late PTE. To compare the curative effects of auricular electroacupuncture, 89 cases of late PTE were divided into an auricular electroacupuncture and a control group according to whether they were treated with auricular electroacupuncture. We further analyzed the influence of sodium valproate and edaravone on the effects of the treatment of PTE with auricular electroacupuncture. Results Among age, cause, use of auricular electroacupuncture, sodium valproate, and edaravone, the use of auricular electroacupuncture was associated with significantly reduced incidence of late PTE (P < 0.05). Compared with the control group, there were more seizure-free cases in the auricular electroacupuncture group (P < 0.01). The total effective rate of the auricular electroacupuncture group was 90%. The seizure-free rate among patients treated with auricular electroacupuncture was significantly reduced, regardless of the use of sodium valproate or edaravone (P < 0.05). Conclusion Auricular electroacupuncture can reduce the incidence of late PTE and is a safe and economical therapy for late PTE.

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Adverse drug reactions associated with six commonly used antiepileptic drugs in southern China from 2003 to 2015

Cited by 26 publications

References 30 publications

External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients

External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients

Incidence rates of severe cutaneous adverse reactions due to antiseizure medication: A nationwide study using health claims data in Korea

Auricular Electroacupuncture for Late Posttraumatic Epilepsy after Severe Brain Injury: A Retrospective Study

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