Department of Neurology, Emory University, Atlanta, GA, USA.
Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Epilepsia. 2018 Mar;59(3):715-723. doi: 10.1111/epi.14010. Epub 2018 Feb 7.
To determine the frequency of older Americans with epilepsy receiving concomitant prescriptions for antiepileptic drugs (AEDs) and non-epilepsy drugs (NEDs) which could result in significant pharmacokinetic (PK) interaction, and to assess the contributions of racial/ethnic, socioeconomic, and demographic factors.
Retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries ≥67 years old in 2009 augmented for minority representation. Prevalent cases had ≥1 ICD-9 345.x or ≥2 ICD-9 780.3x, and ≥1 AED. Among them, incident cases had no seizure/epilepsy claim codes nor AEDs in preceding 365 days. Drug claims for AEDs, and for the 50 most common NEDs within +/- 60 days of the index epilepsy date were tabulated. Interacting pairs of AEDs/NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk.
Interacting drug pairs affecting NED efficacy were found in 24.5% of incident, 39% of prevalent cases. Combinations affecting AED efficacy were found in 20.4% of incident, 29.3% of prevalent cases. Factors predicting higher interaction risk included having ≥ 1 comorbidity, being eligible for Part D low Income Subsidy, and not living in the northeastern US. Protective factors were Asian race/ethnicity, and treatment by a neurologist.
A substantial portion of older epilepsy patients received NED-AED combinations that could cause important PK interactions. The lower frequency among incident vs. prevalent cases may reflect changes in prescribing practices. Avoidance of interacting AEDs is feasible for most persons because of the availability of newer drugs.
确定接受抗癫痫药物 (AED) 和非癫痫药物 (NED) 同时处方的美国老年癫痫患者的频率，这些药物可能会导致显著的药代动力学 (PK) 相互作用，并评估种族/民族、社会经济和人口统计学因素的贡献。
对 2008-2010 年医疗保险索赔进行回顾性分析，选择 2009 年年龄在 67 岁以上的受益人的 5%随机样本进行补充，以增加少数民族的代表性。现患病例至少有 1 个 ICD-9 345.x 或 2 个 ICD-9 780.3x，且至少有 1 种 AED。其中，新发病例在前 365 天内没有癫痫/癫痫索赔代码或 AED。列出 AED 和索引癫痫日期前后 +/- 60 天内最常见的 50 种 NED 的药物索赔。通过文献复习确定影响 AED/NED 相互作用风险的相互作用药物对。使用逻辑回归模型检查影响相互作用风险可能性的因素。
发现影响 NED 疗效的相互作用药物对在 24.5%的新发病例和 39%的现患病例中，影响 AED 疗效的组合在 20.4%的新发病例和 29.3%的现患病例中发现。预测更高相互作用风险的因素包括有≥1 种合并症、有资格获得部分 D 低收入补贴，以及不住在美国东北部。保护因素包括亚洲种族/民族和神经病学家的治疗。
相当一部分老年癫痫患者接受了可能导致重要 PK 相互作用的 NED-AED 组合。与现患病例相比，新发病例的频率较低可能反映了处方实践的变化。由于有更新的药物，大多数人避免使用相互作用的 AED 是可行的。
