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Prioritizing children's medicines for research: a pharmacoepidemiological study of antiepileptic drugs
Author(s) -
Ackers Ruth,
Murray Macey L.,
Besag Frank M. C.,
Wong Ian C. K.
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2006.02842.x
Subject(s) - medicine , lamotrigine , topiramate , levetiracetam , pediatrics , felbamate , pharmacoepidemiology , epidemiology , polypharmacy , incidence (geometry) , epilepsy , family medicine , medical prescription , intensive care medicine , psychiatry , pharmacology , optics , physics
What is already known about this subject • Recently the European Medicines Agency recommended further research in all newly marketed antiepileptic drugs (AEDs). • There is no information in the literature about how AEDs are used in children in primary care. What this study adds • There is a rapid increase in newer AED prescribing to children and adolescents in UK primary care, while prescribing of conventional AEDs is in decline. • The uptake of lamotrigine, topiramate and levetiracetam is rapid, and their prescribing is favoured over the conventional AEDs, particularly in adolescents. • Following concerns about visual field defects with vigabatrin, long‐term safety surveillance of all the newer AEDs is strongly recommended. Aims To investigate the prescribing epidemiology, in UK primary care, of newer antiepileptic drugs (AEDs) compared with conventional AEDs and to identify AEDs for further research in response to the European Medicines Agency report on epilepsy. Methods Subjects aged 0–18 years, from the UK General Practice Research Database, who were prescribed an AED between 1993 and 2005. Prescribing prevalence and incidence, stratified by age and AED, were calculated. Results A total of 7721 subjects were included and 70% were prescribed one drug. Overall prescribing prevalence for all AEDs had increased by 19%. The prevalence (95% confidence interval) of newer AED prescribing had increased fivefold from 0.67 (0.58, 0.76) to 3.20 (3.03, 3.37) per 1000 person‐years. Conversely, the prevalence of conventional AEDs had declined by 17% from 6.63 (6.34, 6.92) per 1000 person‐years to 5.51 (5.28, 5.73). Lamotrigine had 65% of newer AED prescriptions and was the most prescribed newer drug for both the 2–11 years and 12–18 years age groups with prevalences of 1.47 and 2.55 per 1000 person‐years, respectively. Conclusions There is a rapid increase in newer AED prescribing to children and adolescents in UK primary care, while prescribing of conventional AEDs is declining. Since 1997, the prevalence of vigabatrin has fallen, coinciding with the UK safety warnings on visual field defects. The uptake of lamotrigine, topiramate and levetiracetam is rapid and as the safety of these drugs has not been established, they should be prioritized for further research. Following concerns with vigabatrin, long‐term safety surveillance of all newer AEDs is strongly recommended.