Kurvits Katrin, Laius Ott, Uusküla Maia, Haldre Sulev, Rakitin Aleksei
Estonian State Agency of Medicines, Tartu, Estonia.
Estonian State Agency of Medicines, Tartu, Estonia.
Seizure. 2020 Jan 10;76:28-31. doi: 10.1016/j.seizure.2020.01.004.
Valproic acid (VPA) is a widely used anticonvulsant that is effective against most seizure types. Due to its teratogenic effects, its use should be avoided among females of childbearing age, unless other treatments are ineffective or not tolerated. This study aimed to determine the prevalence of VPA use in 2005-2018 in Estonia, with special attention to females of childbearing age.
In this retrospective nationwide population-based cohort study, outpatient prescription data from the national health insurance provider were used. Annual sex- and age-specific prevalence rates were calculated, and changes therein during the study period were evaluated.
The annual rates of VPA use among females of childbearing age increased significantly in 2005-2014. After 2014, the increasing trend stopped; in 2014-2018, the prevalence rates declined slightly [prevalence rate ratio (PRR), 0.94; P = 0.136]. In males of the same age, the increasing trend continued (PRR, 1.08: P = 0.028). Among neurologists, the rate of VPA prescription to females aged <15 and 15-44 years decreased during 2014-2018 (PRR, 0.74; P < 0.001 and PRR 0.72; P < 0.001, respectively); no change in prescription frequency was seen among psychiatrists during this period.
The increasing trend in VPA usage among females of childbearing age in Estonia stopped after 2014, when the European Medicines Agency's strengthened restrictions on VPA use in females were communicated extensively in Estonia. The level of awareness of VPA's harmful effects during pregnancy is lower in the psychiatric community.
丙戊酸（VPA）是一种广泛使用的抗惊厥药物，对大多数癫痫发作类型均有效。由于其致畸作用，除非其他治疗无效或无法耐受，否则育龄女性应避免使用。本研究旨在确定2005年至2018年爱沙尼亚VPA的使用 prevalence，特别关注育龄女性。
在这项基于全国人口的回顾性队列研究中，使用了国家健康保险提供商的门诊处方数据。计算了按性别和年龄划分的年度 prevalence 率，并评估了研究期间的变化情况。
2005年至2014年，育龄女性中VPA的年使用率显著上升。2014年之后，上升趋势停止；在2014年至2018年期间，患病率略有下降[患病率比（PRR），0.94；P = 0.136]。在同一年龄段的男性中，上升趋势持续（PRR，1.08；P = 0.028）。在神经科医生中，2014年至2018年期间，年龄＜15岁和15 - 44岁女性的VPA处方率下降（PRR分别为0.74；P ＜ 0.001和PRR 0.72；P ＜ 0.001）；在此期间，精神科医生的处方频率没有变化。
2014年之后，爱沙尼亚育龄女性中VPA使用的上升趋势停止，当时欧洲药品管理局对女性使用VPA的强化限制在爱沙尼亚得到了广泛传播。精神科领域对VPA在孕期有害影响的认识水平较低。
