Use of antiepileptic drugs and lipid-lowering agents in the United States.
Use of antiepileptic drugs and lipid-lowering agents in the United States.
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DOI：
10.1016/j.yebeh.2014.03.008
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Foley K
中科院分区：
文献类型：
--
作者：
Mintzer S;Maio V;Foley K
在美国，酶诱导抗癫痫药物（EIAEDs）作为一线治疗药物的使用程度尚不清楚。研究表明，EIAEDs会导致血脂升高，这可能需要额外的治疗。我们评估了目前美国癫痫单药治疗中EIAED的使用情况，以及EIAED的使用与随后治疗高脂血症的HMG-CoA还原酶抑制剂（“他汀类药物”）的新处方之间的相关性。我们在2009年7月至2013年1月期间查询了MarketScan®数据库，涵盖了6600万名商业或补充医疗保险患者。我们确定了被诊断为癫痫发作的个体，在癫痫诊断前6个月至24个月连续登记在数据库中，在诊断前未使用AED或他汀类药物，并且至少有1次新的AED处方。我们将开了eaeds（苯妥英、卡马西平、巴比妥类药物）和开了所有其他aaeds的患者的比例制成表格。评估两组患者在AED处方后1 - 24个月内新开他汀类药物的比率，仅限于无血管疾病史且在AED处方后获得脂质血清学结果的患者。在11,893例新治疗的癫痫患者中，2425例（20.4%）开始使用EIAED， 9468例（79.6%）开始使用非诱导性AED。随着年龄的增长，使用EIAEDs的趋势也越来越明显（p<0.0001）。在符合标准的患者中，496例eiaed治疗患者中有66例（13.3%）新开了他汀类药物，1930例非诱发性AED患者中有178例（9.2%）新开了他汀类药物（p < 0.007）。在考虑了年龄和性别后，这一差异仍然显著（p=0.015）。与非诱导性AED相比，启动EIAED的患者随后服用他汀类药物的可能性要高46% （95% CI 1.08-1.98）。在美国，EIAED治疗癫痫的处方似乎随着年龄的增长而增加，尽管缺乏令人信服的理由，这表明美国医生未能认识到EIAED治疗的并发症。与非诱导性aed相比，新开eed的患者更常开始使用他汀类药物。这些初步数据提供了进一步的证据，表明EIAEDs以临床有意义的方式提高血脂。
The extent to which enzyme-inducing antiepileptic drugs (EIAEDs) are used as first-line treatment in the United States remains unknown. Studies suggest that EIAEDs produce elevation of serum lipids, which could require additional treatment. We assessed the current use of EIAED in monotherapy for epilepsy in the U.S., as well as the correlation between use of EIAEDs and subsequent new prescriptions for HMG-CoA reductase inhibitors (“statins”) for hyperlipidemia. We queried the MarketScan® databases between July 2009 to January 2013, covering 66 million patients with commercial or supplemental Medicare insurance. We identified individuals who had a diagnosis of seizures, continuous enrollment in the database from 6 months prior to 24 months after the epilepsy diagnosis, no utilization of an AED or a statin prior to that diagnosis, and at least 1 new AED prescription. We tabulated the fraction who were prescribed EIAEDs (phenytoin, carbamazepine, barbiturates) and those prescribed all other AEDs. Rates of new statin prescription between 1 and 24 months after AED prescription were assessed among the two groups, restricted to those with no prior history of vascular disease who had lipid serology obtained subsequent to the new AED prescription. Of the 11,893 patients with newly-treated epilepsy, 2425 (20.4%) were started on an EIAED, and 9468 (79.6%) were started on a non-inducing AED. There was a consistent and significant trend for EIAEDs to be increasingly prescribed with increasing age (p<0.0001). Among patients meeting the criteria, a statin was newly prescribed in 66 of 496 (13.3%) EIAED-treated patients, and in 178 of 1930 (9.2%) non-inducing AED patients (p < 0.007). This difference remained significant after accounting for age and gender (p=0.015). A patient starting an EIAED was 46% more likely to be subsequently prescribed a statin than a patient started on a non-inducing AED (95% CI 1.08–1.98). EIAED prescription for epilepsy appears to increase with increasing age in the U.S. despite the absence of a cogent rationale for this practice, suggesting a failure to appreciate the complications of EIAED therapy among U.S. physicians. Statins were more often started in those newly-prescribed EIAEDs than to those given non-inducing AEDs. These preliminary data provides further evidence suggesting that EIAEDs elevate lipids in a clinically meaningful manner.
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