Abstract:Objective To summarize the situation of antiepileptic drugs (AEDs) administration and off-label use in epileptic children hospitalized in Children′s Hospital, Capital Institute of Pediatrics (CIP Children Hospital), and investigate the reason for off-label use, and provide evidence for the appropriate administration of AEDs in epileptic children. Methods Demographic and clinical diagnosis and therapy information of epileptic children, including gender, age, seizure types, AEDs administration and and so on, were collected in CIP Children Hospital from January 2011 to December 2015. Based on the label and instruction of AEDs, whether the AEDs administration was off-label use of which types were categorized into off-age, off-seizure types, off-dosage, off-mono/add-on therapy and off-administration frequency were evaluated, and the situation of off-label use of AED was statistically analyzed. Results Totally 865 epileptic children were collected, including 500 males and 365 females. The median age was 2.3 years old. Among them, 724 epileptic children received AEDs therapy, while the other 141 did not (including 82 children with Adrenocorticotropic Hormone, Prednisone, and/or Methylprednisolone therapy). 1120 person-times of AEDs were administrated. The numbers of epileptic children who received 1, 2, 3 and ≥4 AEDs were 492, 125, 55 and 52 cases. The percentage rank of types of off-label use was off-age (35.8%), off-mono/add-on therapy (19.7%), off-seizure types (14.6%), off-dosage (4.5%) and off-administration frequency (2.3%). Moreover, top 3 percentage of AEDs in off-age were Topiramate (72.9%), Levetiracetam Tablets (67.0%), and Oxcarbazepine Liquid (56.7%); top 3 percentage of AEDs in off-seizure types were Levetiracetam Liquid (51.9%), Levetiracetam Tablets (40.8%), Topiramate (26.3%); top 3 percentage of AEDs in off-mono/add-on therapy were Levetiracetam Liquid (81.4%), Levetiracetam Tablets (55.5%), Topiramate (23.7%). Conclusion The off-label use of AEDs is widespread in epileptic children, especially in off-age. The most percentage of off-label use in AEDs were Levetiracetam and Topiramate. The main reason for the off-label use in AEDs is the complication of children epileptic therapy. When the administration of AEDs is an off-label use, the adverse effects and benefits should be evaluated, so that get optimal balance of drug efficacy and safety and promote clinical appropriate drug administration.
杨圣海 王珺 王立文 陈金晓 吴欢欢 徐翠娟. 癫痫儿童抗癫痫药使用情况及超说明书用药的调查分析[J]. 中国医药导报, 2018, 15(11): 45-48.
YANG Shenghai WANG Jun WANG Liwen CHEN Jinxiao WU Huanhuan XU Cuijuan. Survey analysis of antiepileptic drugs prescription and off-label use in children with epilepsy. 中国医药导报, 2018, 15(11): 45-48.
[1] Kwan P,Brodie MJ. Early identification of refractory epilepsy [J]. N Engl J Med,2000,342(5):314-319.
[2] 付海尔,李瑜.药品说明书之外的用法在临床的应用[J].中国医药指南,2009,1(7):80-82.
[3] 刘艺平,彭洋.超说明书用药的利弊思考[J].中南药学,2013,11(1):76-77.
[4] Stafford RS.Regulating off -label drug use-rethinking the role of the FDA [J]. N Engl J Med,2008,358(14):1427.
[5] World Health Organization:Epilepsy [EB/OL]. http://www.who.int/mediacentre/factsheets/fs999/en/. 2017-02.
[6] Gu L,Liang B,Chen Q,et al. Prevalence of epilepsy in the People's Republic of China:a systematic review [J]. Epilepsy Res,2013,105(1-2):195-205.
[7] Ding X,Zheng Y,Guo Y,et al. Active epilepsy prevalence,the treatment gap,and treatment gap risk profile in eastern Chna:A population-based study [J]. Epilepsy Behav,2017,18(78):20-24.
[8] Yu Z,Dong K,Chang H,et al. The epidemiological and clinical characteristics study on epilepsy in 8 ethnic groups of Chin [J]. Epilepsy Res,2017,12(138):110-115.
[9] 高明娥.我院儿科住院患者超说明书用药现状[J].中国药物与临床,2016,16(7):976-978.
[10] 郭春彦,王晓玲.大型综合儿童医院门诊患儿超说明书用药情况调查[J].临床药物治疗杂志,2014,12(2):50-55.
[11] 林芸,魏敦灿,李庆南,等.儿科门诊超说明书用药的调查与分析[J].北方药学,2016,13(3):171-173.
[12] Conroy S,Choonara I,Impicciatore P,et al. Survey of unlicensed and off label drug use in paediatric wards in European countries. European Network for Drug Investigation in Children [J]. BMJ,2000,320(7227):79-82.
[13] Pandolfini C,Bonati M. A literature review on off-label drug use in children [J]. Eur J Pediatr,2005,164(9):552-558.
[14] 蔡浅云,罗蓉,吴惧,等.四川地区新型抗癫痫药物超说明书规定用药分析:一项对儿童患者的多中心调查研究[J].中国现代神经疾病杂志,2012,12(5):536-541.
[15] 蔡鸿福,郑斌,刘茂柏.儿童抗癫痫药物超说明书用药调查分析[J].中国医院药学杂志,2015,35(6):551-554.
[16] 张月华.关注抗癫痫药物的标签外用药[J].中华儿科杂志,2011,49(8):564-566.
[17] Borges AP,Campos MS,Pereira LR. Evaluation of unlicensed and off-label antiepileptic drugs prescribed to children:Brazilian Regulatory Agency versus FDA [J]. Int J Clin Pharm, 2013,35(3):425-431.
[18] Glauser T,Ben-Menachem E,Bourgeois B,et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes [J]. Epilepsia,2013,54(3):551-563.
[19] 中华医学会.临床诊疗指南·癫痫病分册(2015修订版标)[M].北京:人民卫生出版社,2015.
[20] 中华医学会儿科学分会临床药理学组,《中华儿科杂志》编辑委员会.中国儿科超说明书用药专家共识[J].中华儿科杂志,2016,54(2):101-103.