Should enzyme-inducing antiepileptic drugs be considered first-line agents?
Should enzyme-inducing antiepileptic drugs be considered first-line agents?
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DOI：
10.1111/j.1528-1167.2009.02235.x
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发表时间：
2009-01-01
期刊：
影响因子：
5.6
通讯作者：
Mattson, Richard T.
中科院分区：
文献类型：
--
作者：
Mintzer, Scott;Mattson, Richard T.
尽管在过去的20年里引入了许多新的抗癫痫药物（aed），但较老的药物（细胞色素P450 （CYP450）系统的有效诱导剂）仍然是世界上最常用的aed。与此同时，关于CYP450诱导可能产生的不良后果的数据逐渐出现，因此现在可以适当地提出是否仍应将诱导药物视为治疗局灶性癫痫的一线药物的问题。在本文中，我们回顾了表明这些药物可能有许多有害代谢影响的证据，以及与较新的非诱导性aed相比其相对疗效的数据。我们的结论是，需要更长时间和更有力的研究来真正确定新的aed是否与旧的诱导药物具有相同的功效。然而，在此之前，现有的数据足以表明，除非其中一种诱导药物有明确的适应症，否则开始使用非诱导的aed可能是谨慎的。
P>Despite the introduction of a host of new antiepileptic drugs (AEDs) over the last 20 years, the older agents, which are potent inducers of the cytochrome P450 (CYP450) system, remain the AEDs most commonly prescribed throughout the world. At the same time, data have gradually and continuously emerged regarding the possible adverse consequences of CYP450 induction, such that it is now appropriate to pose the question of whether the inducing drugs should still be considered first-line agents for the treatment of focal epilepsy. In this article we review the evidence suggesting that these drugs may have many detrimental metabolic effects, along with the data concerning their relative efficacy compared to the newer, noninducing AEDs. We conclude that longer and better-powered studies are needed to truly establish whether the newer AEDs are equivalent in efficacy to the older, inducing agents. Pending this, however, the extant data are sufficiently concerning to suggest that it may be prudent to start with noninducing AEDs unless there is a clear indication for one of the inducing drugs.