Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein.
Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein.
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DOI：
10.1016/j.yebeh.2016.02.023
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Sperling MR
中科院分区：
文献类型：
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作者：
Mintzer S;Miller R;Shah K;Chervoneva I;Nei M;Skidmore C;Sperling MR
先前的研究表明，患者从诱导抗癫痫药物(AED)转向拉莫三汀、左乙拉西坦或托吡酯可降低血脂和C反应蛋白(CRP)。这些研究都是短期的，一些药物，如唑尼沙胺，还没有被研究过。我们招募了41名服用苯妥英钠或卡马西平的患者，他们被改用唑尼沙胺、拉莫三嗪或左乙拉西坦。我们在转换前、6周后和6个月后分别测定了血脂和C反应蛋白。未经治疗的对照组(n=14)进行了类似的测量。我们将这些数据与我们之前的研究(n=34名患者和16名对照)进行了非常相似的设计。在两个诱导性抗癫痫药之间和三个非诱导性抗癫痫药之间在结果测量上没有差异。在诱导剂治疗下，总胆固醇(TC)、致动脉粥样硬化脂类和C反应蛋白水平高于对照组。与非诱导剂治疗相比，诱导剂治疗后所有指标均升高，包括TC(高24 mg/dL，95%可信区间：17.5-29.9，p<；0.001)和C反应蛋白(高72%，95%可信区间：41-111%，p<；0.001)。药物治疗对致动脉粥样硬化的血脂有临床意义(16%，95%CI：11-20%，p<；0.001)，但对高密度脂蛋白胆固醇的影响不大(5%，95%CI：1-9%，p<；0.05)。换药后6周至6个月，各项指标均稳定。我们证明，从诱导性AEDs转换为非诱导性AEDs可以持久地降低血脂和C反应蛋白。这些结果提供了进一步的证据，表明诱导AEDs可能与血管疾病风险增加有关。这是服用唑尼沙胺的患者中的第一个血管风险标记物数据，它显示出与其他非诱导性AED相似的特征。
Prior studies have shown that switching patients from inducing antiepileptic drugs (AEDs) to lamotrigine, levetiracetam, or topiramate reduces serum lipids and C-reactive protein (CRP). These studies were all of short duration, and some drugs, such as zonisamide, have not been investigated. We recruited 41 patients taking phenytoin or carbamazepine who were being switched to zonisamide, lamotrigine, or levetiracetam. We measured serum lipids and CRP before the switch, >6 weeks after, and >6 months after. An untreated control group (n=14) underwent similar measurement. We combined these data with those of our previous investigation (n=34 patients and 16 controls) of a very similar design. There were no differences in outcome measures between the two inducing AEDs, nor among the three non-inducing AEDs. Total cholesterol (TC), atherogenic lipids, and CRP were higher under inducer treatment than in controls. All measures were elevated under inducer treatment relative to non-inducer treatment, including TC (24 mg/dL higher, 95% CI: 17.5–29.9, p<0.001) and CRP (72% higher, 95% CI: 41–111%, p<0.001). The difference between drug treatments was clinically meaningful for atherogenic lipids (16%, 95% CI: 11–20%, p<0.001) but small for high-density-lipoprotein cholesterol (5%, 95% CI: 1–9%, p<0.05). All measures were stable between 6 weeks and 6 months after drug switch. We demontrate that switching from inducing to non-inducing AEDs produces an enduring reduction in serum lipids and CRP. These results provide further evidence that inducing AEDs may be associated with elevated vascular disease risk. These are the first vascular risk marker data in patients taking zonisamide, which shows a profile similar to that of other non-inducing AEDs.