IQVIA, New York City, NY, United States.
University of Wisconsin School of Pharmacy, Madison, WI, United States.
Epilepsy Behav. 2021 Apr;117:107840. doi: 10.1016/j.yebeh.2021.107840. Epub 2021 Feb 21.
Most antiseizure medications (ASM) need to be titrated before the optimal dose is achieved. Titration can last several weeks to months. We assessed the impact titration schedules have on ASM treatment-related decisions in the United States (US).
An online survey was conducted with different healthcare providers (HCPs) in the US involved in the treatment and management of patients with epilepsy. The survey contained three sections: the first section with screening questions; the second on key factors that influence a HCP's decision-making when selecting treatments for different types of seizures and different treatment lines; and the third on the HCP's knowledge and perceptions regarding ASM titration for the treatment of patients with epilepsy.
One-hundred and fifty HCPs (63% neurologists) completed the survey. Most HCPs considered titration schedule to be important, with only 1-3% of HCPs, depending on type of seizure, considering the titration schedule to be "not important at all" when prescribing therapy. Healthcare providers' acceptance of titration increased with shorter durations (≥50% accepted titration periods of ≤2 weeks), and lower number of tablets/capsules per dose (≥50% accepted ≤3 tablets/capsules per dose), doses (≥50% accepted ≤2 doses/day), and steps (≥50% accepted ≤3 steps/dose change). Most HCPs (68-91% depending on type of seizure) considered a titration duration of 6 or more weeks only somewhat acceptable or somewhat or highly unacceptable. Almost all HCPs selected "somewhat familiar", "familiar", or "very familiar" as the attribute that best defines their knowledge level of titration, with only 4% selecting "a little familiar". While 87% of HCPs agreed or strongly agreed that they could easily understand titration schedules, only 27% of them agreed or strongly agreed that patients could easily understand titration schedules and 58% of HCPs considered that adhering to the titration schedule was difficult for patients. Most HCPs agreed or strongly agreed that a complex or long titration schedule renders it difficult to achieve their treatment objectives.
Healthcare providers take into account the duration and complexity of the titration period in their ASM prescribing decision-making and prefer shorter and simpler titration schedules, particularly for patients who are experiencing convulsive seizures and starting monotherapy. There was a clear difference between the HCP's belief in their own ability to understand a titration schedule, and their belief that the patient would be able to follow the titration schedule appropriately.
大多数抗癫痫药物（ASM）需要在达到最佳剂量之前进行滴定。滴定可能需要数周或数月。我们评估了美国（US）中滴定方案对 ASM 治疗相关决策的影响。
对美国参与癫痫患者治疗和管理的不同医疗保健提供者（HCP）进行了在线调查。该调查包含三个部分：第一部分是筛选问题；第二部分是影响 HCP 为不同类型癫痫发作和不同治疗线选择治疗时决策的关键因素；第三部分是 HCP 对癫痫患者治疗中 ASM 滴定的知识和看法。
150 名 HCP（63%为神经病学家）完成了调查。大多数 HCP 认为滴定方案很重要，只有 1-3%的 HCP，具体取决于癫痫发作的类型，认为在开处方治疗时“完全不重要”。随着滴定期持续时间的缩短（接受滴定期≤2 周的比例≥50%）和每个剂量的片剂/胶囊数（接受每个剂量≤3 片/胶囊的比例≥50%）、剂量（接受每天≤2 次剂量的比例≥50%）和剂量变化的步骤数（接受每剂量变化≤3 步的比例≥50%）的降低，医疗保健提供者对滴定的接受度增加。大多数 HCP（取决于癫痫发作的类型，68-91%）认为 6 周或更长时间的滴定期仅有些可接受或有些或高度不可接受。几乎所有的 HCP（取决于癫痫发作的类型，68-91%）都选择“有些熟悉”、“熟悉”或“非常熟悉”作为最能定义其滴定知识水平的属性，只有 4%的人选择“有点熟悉”。虽然 87%的 HCP 同意或强烈同意他们可以轻松理解滴定方案，但只有 27%的 HCP 同意或强烈同意患者可以轻松理解滴定方案，而 58%的 HCP 认为患者坚持滴定方案很困难。大多数 HCP 同意或强烈同意复杂或漫长的滴定方案使其难以实现治疗目标。
医疗保健提供者在 ASM 处方决策中考虑了滴定期的持续时间和复杂性，并倾向于更短、更简单的滴定方案，特别是对于经历惊厥性癫痫发作和开始单药治疗的患者。HCP 对自己理解滴定方案能力的信念与他们对患者能够适当遵循滴定方案的信念之间存在明显差异。
