Hadgu Rim M, Borghol Amne, Gillard Christopher, Wilson Candice, Elqess Mossa Suzan, McKay Megan, Jastram Charles, Onor Ifeanyi O
Xavier University of Louisiana, New Orleans, USA.
Midwestern University, Glendale, AZ, USA.
Hosp Pharm. 2021 Oct;56(5):486-494. doi: 10.1177/0018578720920803. Epub 2020 May 17.
Amantadine has been used off-label to improve alertness after traumatic brain injury (TBI). The goal of this study is to assess the mean change at 72 hours and in course of therapy (COT) Glasgow Coma Scale (GCS) score after amantadine initiation and to correlate the change in GCS score with participation in physical therapy (PT) and occupational therapy (OT) among patients with TBI receiving amantadine during the first hospitalization. This single-center, retrospective, cohort study included patients ≥18 years old hospitalized for a TBI from August 2012 to February 2018 and received ≥1 dose of amantadine to increase alertness. The primary endpoint is the mean change in 72-hour GCS score after amantadine initiation. The secondary endpoint is the mean change in COT GCS score after amantadine initiation and the correlation between the change in GCS score and percent PT and OT participation at 72 hours and during the COT. Seventy-nine patients were included. The mean age of patients was 41 years, and 79.8% of the patients were men. The mean change in 72-hour GCS score was +0.75 (95% confidence interval [CI] = 0.09-1.42, = .027), and the mean change in COT GCS score was +2.29 (95% CI = 1.68-2.90, < .001). There was no significant correlation between the increase in GCS score and percent PT/OT session participation at 72 hours and during the COT, = -0.15 ( = .24) and = -0.02 ( = .74), respectively. The percent PT/OT session participation at 72-hour post-amantadine initiation was 61.3% compared with 65.9% during the COT. There were small but statistically significant increases in the mean change at 72 hours and in COT GCS score; however, they were not correlated with percent PT/OT participation. Other studies are needed to determine the appropriate time and GCS score to initiate amantadine along with the optimal dose in the inpatient setting.
金刚烷胺已被用于脑外伤（TBI）后提高警觉性的非适应证用药。本研究的目的是评估在首次住院期间接受金刚烷胺治疗的TBI患者中，开始使用金刚烷胺后72小时及整个治疗过程（COT）中格拉斯哥昏迷量表（GCS）评分的平均变化，并将GCS评分的变化与参与物理治疗（PT）和职业治疗（OT）的情况相关联。这项单中心、回顾性队列研究纳入了2012年8月至2018年2月因TBI住院且年龄≥18岁、接受≥1剂金刚烷胺以提高警觉性的患者。主要终点是开始使用金刚烷胺后72小时GCS评分的平均变化。次要终点是开始使用金刚烷胺后COT期间GCS评分的平均变化，以及72小时和COT期间GCS评分变化与PT和OT参与百分比之间的相关性。共纳入79例患者。患者的平均年龄为41岁，79.8%为男性。72小时GCS评分的平均变化为+0.75（95%置信区间[CI]=0.09-1.42，P=.027），COT期间GCS评分的平均变化为+2.29（95%CI=1.68-2.90，P<.001）。72小时和COT期间GCS评分的增加与PT/OT疗程参与百分比之间无显著相关性，分别为r=-0.15（P=.24）和r=-0.02（P=.74）。开始使用金刚烷胺后72小时PT/OT疗程参与百分比为61.3%，COT期间为65.9%。72小时和COT期间GCS评分的平均变化虽小但有统计学意义的增加；然而，它们与PT/OT参与百分比无关。需要其他研究来确定在住院环境中开始使用金刚烷胺的合适时间和GCS评分以及最佳剂量。
