Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center

Assis, Telma; Bacellar, Aroldo; Côrtes, Luan; Santana, Silas; Costa, Gersonita; Nascimento, Osvaldo J. M.

doi:10.1590/0004-282x-anp-2020-0012

Cited by 7 publications

(6 citation statements)

References 33 publications

(41 reference statements)

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“…In recent studies from Sweden 12 (2012–2016), Italy 13 (2013–2018) and Japan 14 (2014–2019), levetiracetam has replaced older‐generation ASMs, and it became the most frequently used ASM for poststroke epilepsy. This transition was also evident in observational cohort studies conducted in England 22 (2003–2016) and Brazil 23 (2009–2019), demonstrating an increased use of newer‐generation ASMs over time among people with epilepsy. This trend could be attributed to the improved safety and tolerability of newer‐generation ASMs 24 …”

Section: Discussionmentioning

confidence: 82%

Shift from older‐ to newer‐generation antiseizure medications in people with acute ischemic stroke in Australia: A population‐based study

et al. 2023

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ObjectiveTo investigate the trends in antiseizure medications (ASM) use following ischaemic stroke and to examine factors associated with use of newer‐ and older‐generation ASMs.MethodsA retrospective cohort study was conducted using state‐wide linked health datasets. Patients who were hospitalised with a first‐ever ischaemic stroke between 2013‐2017 and were dispensed ASM within 12 months from discharge were included. Logistic regression was used to examine the predictors of receiving newer‐generation ASMs. Generalised linear modelling was used to identify factors associated with ASM use after ischaemic stroke.ResultsOf 19,601 people hospitalized with a first‐ever ischaemic stroke, 989 were dispensed an ASM within 12 months from discharge. The most prevalent first ASMs were levetiracetam (38.0%), valproate (25.8%) and carbamazepine (10.3%). Most people were dispensed ASM monotherapy (86.9%). There was a shift towards the use of newer‐generation ASMs between 2013‐2017 (Odds Ratio [OR] 2.82, 95% confidence interval [CI] 1.92‐4.16). Metropolitan residents were more likely to be dispensed newer‐generation ASMs as a first‐line treatment (OR 1.79, 95% CI 1.31‐2.45). People over 85 years (OR 0.38, 95% CI 0.23‐0.64), with dementia (OR 0.35, 95% CI 0.19‐0.63) and psychotic comorbidities (OR 0.29, 95% CI 0.09‐0.96) were less likely to be dispensed newer‐generation ASMs. Older age (coefficient [β] 0.23, p=0.030), history of beta blocker use (β 0.17, p=0.029), multiple ASMs (β 0.78, p<0.001) and newer‐generation ASM (β 0.23, p=0.001) were associated with higher defined daily dose (DDD) of ASM whereas female sex and being married were associated with lower DDD.SignificanceThere has been a shift toward newer‐generation ASMs for post‐stroke seizures and epilepsy. Concerningly, vulnerable patient groups were more likely to be dispensed older‐generation ASMs. This may lead to unnecessary exposure to adverse events and drug‐drug interactions. Further research is needed to evaluate comparative effectiveness and safety of newer‐ and older‐generation ASMs in post‐stroke populations.

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Section: Discussionmentioning

confidence: 82%

Shift from older‐ to newer‐generation antiseizure medications in people with acute ischemic stroke in Australia: A population‐based study

et al. 2023

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“…Finally, our last data were captured in 2014, which means we could not investigate newer ASMs. The drugs studied are still the most commonly prescribed first ASMs among older adults with new-onset epilepsy …”

Section: Discussionmentioning

confidence: 99%

“…155 Internationally, first generation ASMs are commonly used among older adults with new-onset epilepsy. 156,[158][159][160] Sweden is no exception.…”

Section: Figure 2 Flow Chart Of the Eligibility Process Of Paper IIImentioning

confidence: 99%

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Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

et al. 2022

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The relationship between epilepsy and stroke is complicated. While stroke is a major cause of epilepsy after middle age, there is also evidence that the risk of stroke is increased in persons with epilepsy. The overall aim of this dissertation is to elaborate on the prognosis and treatment of epilepsy in older adults and its association to stroke. It is based on four studies which have been conducted using information from linked national registers, which offer unique opportunities to follow thousands of patients over a long period of time.The results from Papers I-II indicate that a significant proportion of all newonset seizures after middle age will herald a subsequent stroke. Using incidence data and population statistics, we estimated the 10-year risk of stroke to be between 5-20%, depending on age group. In relative terms, the risk appears to be almost two-fold (odds ratio [OR] 1.77; 95% confidence interval [95%CI] 1.65-1.89) compared with age-matched controls from the general population -and highest during the first year after seizure onset (OR 2.21; 95 % CI 1.79-2.72).The studies described in Papers III-IV examined prognostic aspects of antiseizure medication (ASM) therapy in poststroke epilepsy. Paper III found the 5-year retention rate to be highest for lamotrigine (0.75, 95%CI 0.70-0.79) and levetiracetam (0.69, 95%CI 0.63-0.74), suggesting these drugs are well tolerated in this patient group. Paper IV used a similar methodology but investigated if mortality varied with different ASMs in monotherapy. Patients treated with lamotrigine had lower mortality (hazard ratio [HR] 0.72, 95%CI 0.60-0.86) than the reference group treated with carbamazepine, while patients treated with valproic acid had higher mortality (HR 1.40, 95%CI 1.23-1.59). Treatment with levetiracetam was associated with a reduced risk of cardiovascular death compared to carbamazepine (HR 0.77, 95%CI 0.60-0.99).In conclusion, this thesis supports a tailored management approach in adults with new-onset seizures late in life, particularly in those with a history of stroke. Persons with late-onset seizures have high vascular risk, potentially warranting screening and treatment for vascular risk factors. Moreover, the association between ASM selection and mortality raises concerns about clinically relevant drug-drug or drug-disease interactions that may modify vascular risk. Overall, lamotrigine and levetiracetam seem sensible initial treatment options in this patient group.

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“…Os pacientes que já são idosos têm propensão em fazerem uso de outros medicamentos, como antidepressivos e antipsicóticos, por apresentarem mais comorbidades. Além disso, apenas o fator envelhecimento já produz alterações fisiológicas capazes de alterar as características farmacocinéticas dos AEDs (Anghelescu et al, 2022;Assis et al, 2021;Baftiu et al, 2018).…”

Section: Valova Et Al 2020unclassified

A polifarmácia para o tratamento da epilepsia na rede pública de saúde: uma revisão integrativa de literatura

Pereira

Nogueira

Brito

et al. 2022

RSD

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Introdução: A epilepsia é uma alteração crônica com modificações das funções cerebrais, podendo levar à perda da consciência e apresenta crises epilépticas parciais ou focais. Existem diferentes etiologias para a epilepsia, caracterizando um tratamento variado de acordo com a particularidade do indivíduo, o que acentua a polifarmácia. Objetivo: Avaliar a polifarmácia relacionada ao tratamento da epilepsia na rede pública brasileira, reconhecendo o uso exacerbado ou inapropriado de medicações. Metodologia: Trata-se de uma revisão integrativa de literatura realizada entre os meses de abril e junho de 2022 nas seguintes bases de dados: National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Cochrane Database of Systematic Reviews (CDSR), Google Scholar, Biblioteca Virtual em Saúde (BVS), Biblioteca Virtual em Saúde (BVS) e EBSCO Information Services. Resultados e discussão: Cerca de 50% dos pacientes com epilepsia consomem múltiplos medicamentos, o que eleva a morbimortalidade devido aos riscos dos efeitos adversos e a capacidade de aumentar as crises epilépticas. A epilepsia propicia a autointoxicação em consequência à polifarmácia, principalmente de idosos, pelas interações farmacológicas, devendo ser monitoras pelos médicos. O Sistema Único de Saúde do Brasil possui assistência farmacêutica que promove o uso racional de medicamentos, buscando selecionar e padronizar os medicamentos que são indicados e disponibilizados. Considerações finais: Os pacientes epilépticos em uso de polifarmácia tendem a desenvolver problemas que atrapalham o desempenho psicossocial e apresentam maior risco de efeitos adversos pelas interações farmacológicas. Portanto, torna-se necessário o uso farmacológico racional pelo balancear dos benefícios e das desvantagens.

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Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center

Cited by 7 publications

References 33 publications

Shift from older‐ to newer‐generation antiseizure medications in people with acute ischemic stroke in Australia: A population‐based study

Shift from older‐ to newer‐generation antiseizure medications in people with acute ischemic stroke in Australia: A population‐based study

Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

A polifarmácia para o tratamento da epilepsia na rede pública de saúde: uma revisão integrativa de literatura

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