Fong J Ky, Chan E Ly, Leung H, Chan I, Chang R Sk, Fong G Cy, Fung E Lw, Lui C Ht, Fung B Bh, Poon T L, Siu D, Wong H T, Yeung E, Yung A Wy, Zhu C Xl
Private practice, Hong Kong.
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Hong Kong Med J. 2017 Feb;23(1):74-88. doi: 10.12809/hkmj166027.
New information about antiepileptic drugs has arisen since the publication of the Hong Kong Epilepsy Guideline in 2009. This article set out to fill the knowledge gap between 2007 and 2016 on the use of antiepileptic drugs in Hong Kong.
Between May 2014 and April 2016, four consensus meetings were held in Hong Kong, where a group comprising 15 professionals (neurologists, paediatricians, neurosurgeons, radiologists, and clinical psychologists) from both public and private sectors aimed to review the best available evidence and update all practising physicians on a range of clinical issues including drug-related matters. All participants were council members of The Hong Kong Epilepsy Society.
A literature review of the clinical use of antiepileptic drugs as monotherapy suggested Level A evidence for levetiracetam and Level B evidence for lacosamide. No change in the level of evidence was found for oxcarbazepine (Level A evidence) or pregabalin (undesignated), and no evidence was found for perampanel. A literature review on the clinical use of antiepileptic drugs as adjunctive therapy suggested Level A evidence for both lacosamide and perampanel. No change to the level of evidence was found for levetiracetam (Level A evidence), oxcarbazepine (Level A evidence), or pregabalin (Level A evidence). A literature search on the use of generic antiepileptic drugs suggested Level A evidence for the use of lamotrigine in generic substitution.
Three lead authors of the Subcommittee drafted the manuscript that consisted of two parts-part A: evidence on new antiepileptic drugs, and part B: generic drugs. The recommendations on monotherapy/adjunctive therapy were presented during the meetings. The pros and cons for our health care system of generic substitution were discussed. The recommendations represent the 'general consensus' of the participants in keeping with the evidence found in the literature.
Recommendations for the use of levetiracetam, lacosamide, oxcarbazepine, pregabalin, and perampanel were made. The consensus statements may provide a reference to physicians in their daily practice. Controversy exists over the use of generic products among patients who are currently taking brand medications. In this regard, approvals from prescriber and patient are pivotal. Good communication between doctors and patients is essential, as well as enlisting the assistance of doctors, nurses, and pharmacists, therapeutic blood monitoring if available, and the option of brand antiepileptic drug as a self-financed item. The physical appearance of generic drugs should be considered as it may hamper drug compliance. Support from medical services is recommended. In the longer term, the benefit of flexibility and the options to have a balance between the generic and brand drug market may need to be addressed by institutions and regulatory bodies.
自2009年《香港癫痫指南》发布以来，出现了关于抗癫痫药物的新信息。本文旨在填补2007年至2016年香港抗癫痫药物使用方面的知识空白。
2014年5月至2016年4月期间，在香港举行了四次共识会议，一个由来自公立和私立部门的15名专业人员（神经科医生、儿科医生、神经外科医生、放射科医生和临床心理学家）组成的小组，旨在审查现有最佳证据，并就包括药物相关问题在内的一系列临床问题向所有执业医生提供最新信息。所有参与者均为香港癫痫学会的理事会成员。
一项关于抗癫痫药物作为单一疗法临床应用的文献综述表明，左乙拉西坦有A级证据，拉科酰胺有B级证据。奥卡西平（A级证据）或普瑞巴林（未指定级别）的证据级别没有变化，而吡仑帕奈没有证据。一项关于抗癫痫药物作为辅助疗法临床应用的文献综述表明，拉科酰胺和吡仑帕奈均有A级证据。左乙拉西坦（A级证据）、奥卡西平（A级证据）或普瑞巴林（A级证据）的证据级别没有变化。一项关于使用通用抗癫痫药物的文献检索表明，拉莫三嗪用于通用替代有A级证据。
小组委员会的三位主要作者起草了由两部分组成的手稿——A部分：新型抗癫痫药物的证据，B部分：通用药物。关于单一疗法/辅助疗法的建议在会议期间提出。讨论了通用替代对我们医疗保健系统的利弊。这些建议代表了参与者与文献中发现的证据一致的“总体共识”。
提出了使用左乙拉西坦、拉科酰胺、奥卡西平、普瑞巴林和吡仑帕奈的建议。这些共识声明可为医生的日常实践提供参考。目前正在服用品牌药物的患者在使用通用产品方面存在争议。在这方面，开处方者和患者的批准至关重要。医生与患者之间的良好沟通至关重要，以及争取医生、护士和药剂师的协助，如有条件进行治疗性血药监测，以及将品牌抗癫痫药物作为自费项目的选择。应考虑通用药物的外观，因为它可能会妨碍药物依从性。建议获得医疗服务的支持。从长远来看，机构和监管机构可能需要解决灵活性的好处以及在通用药物和品牌药物市场之间取得平衡的选择问题。
