Availability of antiepileptic drugs across Europe

Baftiu, Arton; Landmark, Cecilie Johannessen; Nikaj, Valent; Neslein, Inger Lise; Johannessen, Svein I.; Perucca, Emilio

doi:10.1111/epi.13210

Cited by 14 publications

(11 citation statements)

References 15 publications

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“…There also seems to be some regional catch‐up in the provision of epilepsy care. Although differences between the regions still exist, for instance, regarding the availability of AEDs, a finding in agreement with another recent report, regional differences seem less evident than in the last survey, especially within the EU. For countries within the EU, the high cost of AEDs did not seem to be the most important problem and was reported as such by only 1 of 23 (4%) EU chapters, in contrast to the whole group, from which 4 of 33 chapters considered this an important problem (12%).…”

Section: Discussionsupporting

confidence: 88%

The provision of epilepsy care across Europe 2017: A 17‐year follow‐up survey

et al. 2019

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Summary Objective To assess the resources available in the provision of epilepsy care across Europe and the developments since the International League Against Epilepsy (ILAE) survey published in 2003 (data collected in 2000). Methods An updated online version of the European Epilepsy Services Inventory was distributed to all European chapters of the ILAE (N = 47) and responses were obtained from 33 chapters (response rate 70%). To assess trends and allow comparisons with the survey published in 2003, the responding countries were divided into 4 groups (Western, Central, Southern, and Eastern). Responses from European Union (EU) member states are reported as a subgroup (N = 23), since the current survey is a part of the EU‐funded European Study on the Burden and Care of Epilepsy (ESBACE, https://www.esbace.eu). Results The total number of physicians involved in epilepsy care had increased since 2000, with the largest increase seen for neurologists. The gap between the best‐ and the least‐provided areas with regard to the competence of the providers had diminished. However, the density of comprehensive multidisciplinary epilepsy teams had not changed to any greater degree. The main problems reported by the chapters were to a large extent the same as in 2000 and included lack of specialists and specialist care, lack or underuse of epilepsy surgery, and problems regarding financing and resource allocation. Several chapters also highlighted problems with healthcare structure and organization. Significance Although there have been some improvements concerning the availability of care for people with epilepsy in Europe over the last 17 years, there are still a number of problem areas with little improvement or where there are important regional differences.

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Section: Discussionsupporting

confidence: 88%

The provision of epilepsy care across Europe 2017: A 17‐year follow‐up survey

et al. 2019

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“…The burden is even more dramatic in rural areas where in addition to a low availability the sustainability of drugs supply is often not guaranteed (Perucca 2007 ). This situation could also be seen in developed European countries where the median availability of all type of AEDs (older and newer) is 82 % ranging from 48 to 100 % (Baftiu and Johannessen 2015 ). Madagascar is not spared, with a high prevalence of epilepsy (23.5/1000) (Ba-Diop et al 2014 ).…”

Section: Introductionmentioning

confidence: 87%

Availability and cost of major and first-line antiepileptic drugs: a comprehensive evaluation in the capital of Madagascar

et al. 2016

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Background The prevalence of epilepsy is high in Madagascar (23.5/1000), as is the treatment gap (estimated at 92 %). The health system of the country is underfunded; some AEDs are used, and the national drug policy does not encourage price regulation or the administration of generic agents. We conducted a cross-sectional study to assess the availability and cost of solid oral AED formulations in Antananarivo, capital of Madagascar. Data were gathered from all officially registered pharmacies (according to the drug agency list, updated in 2015) by means of telephone interviews lasting no more than 10 min and conducted by a native Malagasy speaker. With regard to other sources (hospitals, illicit sales) data were obtained at specific visits. The study received ethical approval from the Madagascar Ministry of Health.Findings A total of 91 of 100 pharmacies (the nine not included were because of an inoperative phone number), two of three public hospitals, and two illegal outlets were investigated. Sodium valproate was available in 84.6 % of the pharmacies, while carbamazepine and phenobarbital were available in 68.1 % and 36.3 % of the pharmacies, respectively, but phenytoin was not available in any supply chain. There were more originator brands than generic formulations, with a higher cost (range 20.3–81.1 %, median 40.7 %) compared to the equivalent generic. The public system had only a very limited choice of AED, but offered the lowest costs. Illicit sources were more expensive by 54.3 % for carbamazepine and 62.5 % for phenobarbital. Concerning the annual cost of treatment, the average percentage of the gross national income per capita based on the purchasing power parity was 29.8 %/19.0 % (brand/generic) for sodium valproate, 16.4 %/7.3 % (brand/generic) for carbamazepine, 8.9 %/5.1 % (brand/generic) for phenobarbital.ConclusionsThe main sources of AEDs were private pharmacies, but the stocks held were low. The financial burden was still important in the capital of Madagascar, mainly the consequence of a highly developed private sector at the expense of the public sector. Although sodium valproate remains the most expensive solution, it still remains the most available instead of phenobarbital. The most striking feature of this study concerns the cost of AEDs in the informal sector, mostly used because they are deemed to provide less costly drugs, the opposite was observed there. The assessment of the cost and availability of medicines was easily and quickly implemented. It provided a relevant focus of the situation in areas difficult to investigate, in terms of road network and geographical situation.

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“…We included individuals that were exposed to LTG, VPA, or LEV. Besides carbamazepine (CBZ), these are the most commonly used ASMs in Europe and are broadly available . They are approved for use in both focal epilepsy (FE) and GGE.…”

Section: Methodsmentioning

confidence: 99%

Testing association of rare genetic variants with resistance to three common antiseizure medications

et al. 2020

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Objective: Drug resistance is a major concern in the treatment of individuals with epilepsy. No genetic markers for resistance to individual antiseizure medication (ASM) have yet been identified. We aimed to identify the role of rare genetic variants in drug resistance for three common ASMs: levetiracetam (LEV), lamotrigine (LTG), and valproic acid (VPA). Methods: A cohort of 1622 individuals of European descent with epilepsy was deeply phenotyped and underwent whole exome sequencing (WES), comprising 575 taking LEV, 826 LTG, and 782 VPA. We performed gene-and gene set-based collapsing analyses comparing responders and nonresponders to the three drugs to determine the burden of different categories of rare genetic variants. Results: We observed a marginally significant enrichment of rare missense, truncating, and splice region variants in individuals who were resistant to VPA compared to VPA responders for genes involved in VPA pharmacokinetics. We also found a borderline significant enrichment of truncating and splice region variants in the synaptic vesicle glycoprotein (SV2) gene family in nonresponders compared to responders to LEV. We did not see any significant enrichment using a gene-based approach. Significance: In our pharmacogenetic study, we identified a slightly increased burden of damaging variants in gene groups related to drug kinetics or targeting in individuals presenting with drug resistance to VPA or LEV. Such variants could thus determine a genetic contribution to drug resistance.

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Availability of antiepileptic drugs across Europe

Cited by 14 publications

References 15 publications

The provision of epilepsy care across Europe 2017: A 17‐year follow‐up survey

The provision of epilepsy care across Europe 2017: A 17‐year follow‐up survey

Availability and cost of major and first-line antiepileptic drugs: a comprehensive evaluation in the capital of Madagascar

Testing association of rare genetic variants with resistance to three common antiseizure medications

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