Cohen Simon A, Lawson John A, Graudins Linda V, Pearson Sallie-A, Gazarian Madlen
Department of Paediatric Neurology, Sydney Children's Hospital, Randwick, Australia.
J Paediatr Child Health. 2012 Jun;48(6):490-5. doi: 10.1111/j.1440-1754.2011.02223.x. Epub 2011 Nov 3.
The evidence-base guiding choices between newer versus established anticonvulsants in children is limited. Inappropriate use exposes children to potentially ineffective and/or harmful medicines. Our objective is to describe recent anticonvulsant prescribing patterns in the Australian paediatric population, evaluating overall trends and extent of off-label prescribing of newer agents.
Aggregated national data on 15 anticonvulsants with Pharmaceutical Benefits Scheme subsidy dispensed by community pharmacies for children aged <16 years were obtained from the Drug Utilisation Subcommittee, which is part of the Australian Government Department of Health and Ageing. We analysed trends for the five most prescribed anticonvulsants dispensed between 2002 and 2009 and off-label prescribing for agents where approved Australian product information stipulates a minimum age.
Valproate was the most frequently prescribed anticonvulsant with no marked change in prescription numbers per 1000 children aged 0-16 years (11.3-11.8 prescriptions/year). Lamotrigine was the most frequently prescribed newer anticonvulsant (7.9-9.3 prescriptions/year). Carbamazepine prescriptions decreased by 38% and topiramate prescriptions increased by 19% over the 7-year study period; 3.6% of topiramate prescriptions were off-label (by age) for children aged <2 years. Since Pharmaceutical Benefits Scheme listing in 2003, levetiracetam prescriptions increased steeply to 2.5 prescriptions/year per 1000 children in 2009; 4.2% were off-label for children aged <4 years.
The substantial reduction in carbamazepine use and corresponding increase in newer anticonvulsant prescribing, including off-label uses, raises questions about potentially suboptimal Quality Use of Medicines. Such major changes in prescribing may have important clinical and economic consequences. Further study to better understand paediatric prescribing choices and outcomes is needed.
指导儿童选用新型抗惊厥药还是传统抗惊厥药的循证依据有限。不合理用药会使儿童接触到可能无效和/或有害的药物。我们的目标是描述澳大利亚儿科人群近期的抗惊厥药处方模式，评估总体趋势以及新型药物的超说明书用药情况。
从澳大利亚政府卫生与老龄部下属的药物利用小组委员会获取了社区药房为16岁以下儿童发放的15种有药品福利计划补贴的抗惊厥药的全国汇总数据。我们分析了2002年至2009年期间最常开具的5种抗惊厥药的趋势，以及澳大利亚批准的产品信息规定了最低使用年龄的药物的超说明书用药情况。
丙戊酸盐是最常开具的抗惊厥药，每1000名0至16岁儿童的处方数量没有明显变化（每年11.3 - 11.8张处方）。拉莫三嗪是最常开具的新型抗惊厥药（每年7.9 - 9.3张处方）。在7年的研究期内，卡马西平的处方量下降了38%，托吡酯的处方量增加了19%；2岁以下儿童的托吡酯处方中有3.6%属于超说明书（按年龄）用药。自2003年列入药品福利计划以来，左乙拉西坦的处方量急剧增加，到2009年每1000名儿童每年达2.5张处方；4岁以下儿童的处方中有4.2%属于超说明书用药。
卡马西平使用量的大幅减少以及新型抗惊厥药（包括超说明书用药）处方量的相应增加，引发了关于药物使用质量可能欠佳的问题。如此重大的处方变化可能会产生重要的临床和经济后果。需要进一步开展研究，以更好地了解儿科处方选择和结果。
