Therapeutic Drug Monitoring of Levetiracetam and Lamotrigine: Is There a Need?
Therapeutic Drug Monitoring of Levetiracetam and Lamotrigine: Is There a Need?
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DOI：
10.1097/ftd.0000000000000158
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发表时间：
2015-08-01
影响因子：
2.5
通讯作者：
Fleming, Denise H.
中科院分区：
文献类型：
--
作者：
Naik, Girish S.;Kodagali, Rohit;Fleming, Denise H.
背景：本研究是对临床环境中收集的左乙拉西坦和拉莫三嗪治疗药物监测数据的回顾性评估。估计与拉莫三嗪和左乙拉西坦血清浓度治疗范围相关的患者比例，并研究年龄和抗惊厥药物对其清除率的影响。方法：获得左乙拉西坦（2011-2013年）和拉莫三嗪（2008-2013年）剂量、谷浓度、年龄、性别、体重和处方抗惊厥药物的信息来自治疗药物监测登记册和存档的医疗记录。根据抗惊厥药物将患者分为 4 组，并根据年龄进一步分为 3 个亚组（a：= 18 岁）。在每个亚组中，计算达到左乙拉西坦和拉莫三嗪治疗范围内谷浓度的患者比例。通过单因素方差分析比较各亚组的表观清除率 (CL/F)，并通过逐步多元线性回归确定显着预测 CL/F 的因素。 结果：总体而言，分析中纳入了 348 个（330 名患者）和 706 个（493 名患者）左乙拉西坦和拉莫三嗪样本。其中，56.9%和72.4%分别低于左乙拉西坦和拉莫三嗪的治疗范围，分别为43.1%和23.9%、0%和3.7%。左乙拉西坦 (P < 0.001) 和拉莫三嗪 (P < 0.001) 的亚组间 CL/F 存在显着差异。年龄 = 18 岁，诱导剂药物显着预测左乙拉西坦的 CL/F。对于拉莫三嗪、抑制剂药物、年龄
Background:This study was a retrospective assessment of the therapeutic drug monitoring data collected for levetiracetam and lamotrigine from a clinical setting. The proportion of patients in relation to the therapeutic ranges for serum concentrations of lamotrigine and levetiracetam was estimated, and the influence of age and anticonvulsant comedications on their clearances were studied.Methods:Information on levetiracetam (2011-2013) and lamotrigine (2008-2013) dose, trough concentration, age, sex, body weight, and anticonvulsant comedications prescribed was obtained from the therapeutic drug monitoring register and archived medical records. Patients were categorized into 4 groups based on anticonvulsant comedications and further divided into 3 subgroups based on age (a: = 18 years). In each subgroup, the proportion of patients who achieved trough concentrations in the therapeutic range for levetiracetam and lamotrigine was computed. Apparent clearance (CL/F) was compared across subgroups by 1-way analysis of variance, and factors which significantly predicted CL/F were identified by stepwise multiple linear regression.Results:Overall, 348 (330 patients) and 706 (493 patients) samples for levetiracetam and lamotrigine were included in the analysis. Of these, 56.9% and 72.4% were within, 43.1% and 23.9% below, 0% and 3.7% above the therapeutic range for levetiracetam and lamotrigine, respectively. A significant difference in CL/F was noted across subgroups for levetiracetam (P < 0.001) and lamotrigine (P < 0.001). Age = 18 years, and inducer comedications significantly predicted CL/F for levetiracetam. For lamotrigine, inhibitor comedications, age