The association between antiepileptic drug and HMG-CoA reductase inhibitor co-medication and cholesterol management in patients with epilepsy
The association between antiepileptic drug and HMG-CoA reductase inhibitor co-medication and cholesterol management in patients with epilepsy
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DOI：
10.1016/j.eplepsyres.2010.07.021
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发表时间：
2010-10-01
影响因子：
2.2
通讯作者：
Gidal, Barry E.
中科院分区：
文献类型：
--
作者：
Candrilli, Sean D.;Manjunath, Ranjani;Gidal, Barry E.
目的：酶诱导抗癫痫药（EIAED）和他汀类药物的药代动力学相互作用已得到证实;然而，其临床意义尚未明确。本研究的目的是评估协会EIAEDs和非酶诱导抗癫痫药物（NEIAEDs）对他汀类药物剂量调整和低密度脂蛋白（LDL）胆固醇水平在patients with epilepsy.Methods：回顾性保险索赔从2000年至2006年的Ingenix影响（原综合医疗保健信息服务）数据库进行了分析。比较了两个队列，EIAED+他汀类药物和NEIAED+他汀类药物：分析了1118例患者（58%男性; 66%年龄>55岁）; 506例（45%）开始使用EIAED。评估的结果包括他汀类药物剂量调整，以及在12个月随访期间，一部分受试者平均LDL >100 mg/dL的风险。描述性统计量进行计算和回归模型estimated.Results：在EIAED组，72%开始与苯妥英钠;在NEIAED组，57%开始与加巴喷丁。对于EIAED组，他汀类药物剂量上调的风险显著更大（比值比= 1.36; P=0.04）;同样，平均LDL >100 mg/dL的风险显著高于NEIAED组。（比值比= 41.22; P=0.005），并在随访期间增加（+26.6 mg/dL; P=0.001）。讨论：这项研究表明，EIAED和他汀类药物的合并使用可能与他汀类药物的临床有效性降低有关。同时使用EIAED和他汀类药物的癫痫患者可能需要更高的警惕性，以实现最佳胆固醇管理。(C)2010 Elsevier B. V.保留所有权利。
Purpose: Pharmacokinetic interactions have been demonstrated in enzyme-inducing antiepileptic drugs (EIAEDs) and statins; however, their clinical significance is not well established. The purpose of this study was to evaluate the association of EIAEDs and non-enzyme-inducing antiepileptic drugs (NEIAEDs) on statin dose adjustments and low-density lipoprotein (LDL) cholesterol levels in patients with epilepsy.Methods: Retrospective insurance claims from 2000 to 2006 from the Ingenix Impact (formerly Integrated Health Care Information Services) database were analyzed. Two cohorts were compared, EIAEDs + statin and NEIAEDs + statin: 1118 patients were analyzed (58% men; 66% aged >55 years); 506 (45%) initiated with an EIAED. Outcomes assessed included statin dose adjustments and, for a subset of subjects, risk of mean LDL >100 mg/dL during the 12-month follow-up period. Descriptive statistics were calculated and regression models estimated.Results: Among the EIAED group, 72% initiated with phenytoin; among the NEIAED group, 57% initiated with gabapentin. For the EIAED group, the risk of upward statin dose adjustments was significantly greater (odds ratio = 1.36; P=0.04) compared with the NEIAED group; similarly, the risk of having mean LDL >100 mg/dL was significantly greater (odds ratio = 41.22; P=0.005) and increased during the follow-up period (+26.6 mg/dL; P=0.001) for the EIAED group.Discussion: This study suggests that concomitant use of EIAEDs and statins may be associated with reduced clinical effectiveness of statins. Patients with epilepsy who use EIAEDs and statins concomitantly may require greater vigilance for optimal cholesterol management. (C) 2010 Elsevier B.V. All rights reserved.