Disseminating Findings from a Drug Class Review: Using Best Practices to Inform Prescription of Antiepileptic Drugs for Bipolar Disorder

Abstract

Evidence from drug class reviews is often not accessible to practicing clinicians nor is it presented in a way that allows clinicians to use the information to guide treatment and prescribing decisions. Nevertheless, information from such reviews can be very helpful to clinicians as they evaluate the "evidence" provided to them through marketing strategies implemented, primarily, by the pharmaceutical industry and designed to influence their prescribing behavior. Unfortunately, these marketing strategies can be used to promote the off-label use of drugs that may not be efficacious. One example is the pharmaceutical marketing to promote off-label use of gabapentin (Neurontin) for the treatment of bipolar disorder, the legality of which was later addressed in a major lawsuit by the National Association of Attorneys General. We describe an effort to use counter-marketing strategies to compete with those implemented by the pharmaceutical industry and to help clinicians, principally psychiatrists, make use of available evidence to inform their prescription of antiepileptic drugs (AEDs) in the treatment of bipolar disorder. A growing body of literature describes industry marketing practices designed to influence prescriber behavior. This literature suggests that use of competing approaches involving the same underlying strategies to deliver highly credible information from trusted sources can inform prescriber knowledge and prescribing practice. We describe our use of existing evidence to develop accurate and convincing messages and materials to be disseminated nationally to counter industry misinformation and promote evidence-based prescription of AEDs.

Predictors of Polypharmacy and Off-Label Prescribing of Psychotropic Medications

“…Interestingly, we did not find that more positive attitudes toward empirical evidence, reading journal articles, or talking to colleagues significantly influenced prescribing practices in either period. It may be that respondents were aware of the findings through other means (e.g., information from pharmaceutical companies or thought leaders in the field 52 ) or that some other variable not included in the survey influenced their decision.…”

Valproate Prescription Prevalence Among Women of Childbearing Age

“…Informing patients and providers about the comparative reproductive risks among mood stabilizers as well as about the evidence to support the efficacy of only a subset of anticonvulsants for bipolar disorder is a necessary component of influencing practice patterns (10). The benefit of valproate treatment may outweigh the risks, such as for young women who are nonresponsive to alternative mood stabilizers.…”